| THE UTILITY OF NON-CONTRAST CT IN THE PROMPT DIAGNOSIS OF POST-OPERATIVE COMPLICATIONS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY. | |
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MedLine Citation:
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PMID: 22192107 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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INTRODUCTION: Non-contrast computerized tomography (CT) is commonly utilized following percutaneous nephrolithotomy (PNL) to assess stone-free (SF) status. In addition to assessing SF status, CT is useful in the recognition of complications following PNL. We characterized complications demonstrated by post-op CT scan and compared hospital re-admission rates based on whether or not CT was performed. METHODS: We retrospectively reviewed records of 1032 consecutive patients from April 1999 to June 2010. Patients were divided into two cohorts based on whether they had a CT within 24 hours of PNL. Demographic data, CT findings, and need for re-admission for complication management were assessed. RESULTS: 957 patients (92.7%) underwent post-PNL CT. CT diagnosed complications were: perinephric hematoma in 41 (4.3%; 2 requiring embolization, and 9 necessitating transfusion), pleural effusion in 25 (2.6%; 10 requiring intervention), colon perforation in 2 (0.2%), and splenic injury in 2 (0.2%). Of patients with post-op complications, 33% required intervention. Among patients with a CT, 6 (0.6%) were readmitted despite negative post-op CT (4 perinephric hematomas, 1 calyceal-pleural fistula and 1 pseudoaneurysm). The sensitivity of CT for diagnosing complications was 92.7%. Seventy-five patients (7.3%) did not undergo CT post-PNL. Of these, 4 (5.33%) were readmitted; 3 for perinephric hematomas and one for ureteral clot obstruction. Patients undergoing post-PNL CT were less likely to be readmitted due to missed complications (p=0.02). CONCLUSIONS: Serious post-PNL complications are uncommon but their prompt diagnosis and treatment is imperative. In addition to identifying residual stones, CT is useful in diagnosing post-op complications. Post-op CT could potentially be considered for all patients undergoing PNL, particularly in complex cases such as patients with anatomical abnormalities (renal anatomic abnormality or retrorenal colon), patients requiring upper pole access (risk of thoracic, hepatic and splenic complications) and patients requiring multisite access (higher risk of perinephric hematoma or need for transfusion). |
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Authors:
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Ehud Gnessin; Jessica A Mandeville; Shelly E Handa; James Lingeman |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-22 |
Journal Detail:
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Title: Journal of endourology / Endourological Society Volume: - ISSN: 1557-900X ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8807503 Medline TA: J Endourol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Methodist, Hospital, Indianapolis, Indiana, United States; ehud.gnessin@gmail.com. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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