title: Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy.
abstract: BACKGROUND
  Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy (PNL) still lack consensus.
  
  
  OBJECTIVE
  To review the epidemiology of complications and their prevention and management.
  
  
  METHODS
  A literature review was performed using the PubMed database between 2001 and May 1, 2011, restricted to human species, adults, and the English language. The Medline search used a strategy including medical subject headings (MeSH) and free-text protocols with the keywords percutaneous, nephrolithotomy, PCNL, PNL, urolithiasis, complications, and Clavien, and the MeSH terms nephrostomy, percutaneous/adverse effects, and intraoperative complications or postoperative complications.
  
  
  RESULTS
  Assessing the epidemiology of complications is difficult because definitions of complications and their management still lack consensus. For a reproducible quality assessment, data should be obtained in a standardized manner, allowing for comparison. An approach is the validated Dindo-modified Clavien system, which was originally reported by seven studies. No deviation from the normal postoperative course (Clavien 0) was observed in 76.7% of PNL procedures. Including deviations from the normal postoperative course without the need for pharmacologic treatment or interventions (Clavien 1) would add up to 88.1%. Clavien 2 complications including blood transfusion and parenteral nutrition occurred in 7%; Clavien 3 complications requiring intervention in 4.1.%; Clavien 4, life-threatening complications, in 0.6%; and Clavien 5, mortality, in 0.04%. High-quality data on complication management of rare but potentially debilitating complications are scarce and consist mainly of case reports.
  
  
  CONCLUSIONS
  Complications after PNL can be kept to a minimum in experienced hands with the development of new techniques and improved technology. A modified procedure-specific Clavien classification should be established that would need to be validated in prospective trials.
authors: Department of Urology, St. John of God Hospital, Teaching Hospital of the Medical University of Vienna, Austria. drseitz@gmx.at
authors: Christian
authors: C
authors: Seitz
authors: Mahesh
authors: M
authors: Desai
authors: Axel
authors: A
authors: Häcker
authors: Oliver W
authors: OW
authors: Hakenberg
authors: Evangelos
authors: E
authors: Liatsikos
authors: Udo
authors: U
authors: Nagele
authors: David
authors: D
authors: Tolley
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D052878:Urolithiasis / Q000453:epidemiology / Q000628:therapy*