📃 Paper Title: Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy
🧍 Author: Christian Seitz
🕒 Year: 2012
📚 Journal: European Urology
🌎 Country: Austria
ㅤContext to the study:
Can you tell me about a study highlighting the efficacy and safety of Percutaneous Nephrolitholapaxy for the management of Renal Stones?
ㅤ✅ Take-home message of study:
Percutaneous nephrolitholapaxy (PNL) is a common and safe surgical procedure with low-rate complications.
Careful patient selection, preoperative urine culture with appropriate antibiotic therapy and prophylaxis can prevent complication rates. Stone burden, number and size of access tracts, procedure duration, preoperative hemoglobin institutional experience also affect complication rates.
A modified Clavien classification is recommended to be used to monitor outcomes following PNL in different centers.
ㅤ Literature review
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Study participants:
Participants: 7312 patients (115 studies from 2001 until 1st May 2011)
Inclusion: studies (n > 50 patients) reporting any relationship between PNL and complication rates, preventive measures, or management of complications (detailed as per Dindo-Clavien system or allowing translation into the Clavien classification)
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Key study outcomes:
The Dindo-modified Clavien system was used to categorize the complications based on their severity and should be validated at a large-scale to obtain a standardization to report complications.
Review showed that 76.7% of PNL procedures had no deviation from the normal postoperative course (Clavien 0). Clavien 1 (88.1%); Clavien 2 (7%); Clavien 3 (4.1%); Clavien 4 (0.6%); Clavien 5 - mortality (0.04%).
High-quality data on the management of rare but potentially debilitating complications are scarce and mainly consist of case reports.
Key preventive measures for complications: ensure that PNL is performed for the appropriate indications, with careful selection and preparation of patients; consider preoperative urine culture and appropriate antibiotic therapy and prophylaxis, and establish access via a meticulous technique.
Stone burden, the number and size of access tracts, duration of the procedure, preoperative hemoglobin levels, and institutional experience and specialization also affect complication rates.
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Study Limitations:
The review was limited to studies published in English between 2001 and May 1, 2011, and the generalizability of the findings may be limited by the variability in PNL techniques and expertise among different centers. Additionally, the lack of standardization in the definitions and management of complications makes it challenging to assess and compare data.
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