Complications of percutaneous nephrolithotomy:: risk factors and management

Extra corporeal shock wave lithotripsy (ESWL) has significantly modified the management of urinary lithiasis. It constitutes usually the first tine treatment of urinary calculi sized less than 30 mm. Complex and staghorn calculi may be treated either with percutaneous nephrolithotomy (PCNL) or by flexible uteroscopy (URS) with Holmium laser. PCNL is a minimal invasive technique but it carries a potential risk of complications: infection, bleeding, urinary fistulas and perforations of adjacent organs. PCNL complications may be prevented by the strict respect of technical recommendations; their therapeutic management has been property codified. In order to reduce the risk of their occurrence, the so-called "mini-perc" (mini-percutaneous technique) has been developed for children and can be applied to adults. Technical details of the two techniques and the treatment of PCNL complications had been described before 1985; the current chapter proposes an update on their prevention and management. (c) 2006 Elsevier SAS. Tous droits reserves.