10/14/2016 1 COMPLICATIONS WITH PERCUTANEOUS NEPHROLITHOTOMY 1. Incidence 2. Non-hemorrhagic Complications Manoj Monga MD The Cleveland Clinic THE CLINICAL RESEARCH OFFICE OF THE ENDOUROLOGICAL SOCIETY (CROES) PERCUTANEOUS NEPHROLITHOTOMY (PCNL) GLOBAL STUDY: INDICATIONS, COMPLICATIONS AND OUTCOMES IN 5803 PATIENTS De la rosette and CROES • 96 centres worldwide. • Complications – significant bleeding (8%) – renal pelvis perforation (3%) – Hydrothorax (2%) – Blood transfusion (6%) – fever >38.5 °C (11%) Risks of PCNL • Chicago • 11,721 patients • National Inpatient Sample for 2002-2008 • Mortality rate 0.3% - Stable • Transfusion rate – 5% - Increasing – Higher – small hospitals, elderly • Chest tube - 1% – Higher – teaching hospitals, young (<30) • Need for a chest tube or blood transfusion – 3-fold increase in length of stay and hospital charge. AUA 2011(Abstract 1686) Prevention: Pick the right patient STONE SIZE >15MM Y N Anticoagulation Pleura on CT PCNL URS SWL Anticoagulation HU >1200 STSD >12 CM LP 10-15mm N Y Y N PD23‐01: The effect of continued aspirin therapy in patients undergoing PCNL Brandon Otto, Forat Lutfi, Russell Terry, Mohit Gupta, Vincent G Bird, Gainesville, FL • 77/285 (27%) PCNL’s ‐ on aspirin therapy (86% on 81mg daily) • Compared aspirin (n= 77) to NO aspirin (n= 208) • NO SIGNIFICANT DIFFERENCES • Residual fragments • Periop change in Hgb/Hct, creatinine • 30‐day complication rate – bleeding or thrombotic events • PCNL appears both effective and safe in patients continuing ASA perioperatively READMISSION AND COMPLICATION RATES IN PATIENTS UNDERGOING PCNL, STRATIFIED BY CO-MORBID FACTORS N. Ginzburg, D. Hoenig, A.A. Hakimi, A. Ovadia, D. Faleck Albert Einstein / Montefiore – Bronx USA • Diabetics – higher readmission rates (p<0.001) – more emergency room visits (p=0.017) • BMI – Higher readmission rates (p=0.039).
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Risks of PCNL Prevention: Pick the right patient 4 The Effect of Prone‐Flexed Positioning (PFP) on Airway Pressures During Percutaneous Nephrolithotomy (PCNL) K Foell, M Ordon, T
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10/14/2016
1
COMPLICATIONS WITH PERCUTANEOUS
NEPHROLITHOTOMY1. Incidence
2. Non-hemorrhagic Complications
Manoj Monga MD
The Cleveland Clinic
THE CLINICAL RESEARCH OFFICE OF THE ENDOUROLOGICAL SOCIETY (CROES)
PERCUTANEOUS NEPHROLITHOTOMY (PCNL) GLOBAL STUDY:INDICATIONS, COMPLICATIONS AND OUTCOMES IN 5803
PATIENTSDe la rosette and CROES
• 96 centres worldwide.
• Complications
– significant bleeding (8%)
– renal pelvis perforation (3%)
– Hydrothorax (2%)
– Blood transfusion (6%)
– fever >38.5 °C (11%)
Risks of PCNL• Chicago• 11,721 patients • National Inpatient Sample for 2002-2008• Mortality rate 0.3% - Stable• Transfusion rate – 5% - Increasing