COMPLICATIONS

The major complications associated with PCNL are hemorrhagic. Occasionally, PCNL procedures need to be aborted before complete stone ablation if bleeding prohibits adequate stone visualization. Bleeding is most commonly venous in origin, and it can be controlled by inflation of the balloon to achieve a tamponade effect. Bright red blood is a sign of arterial bleeding and should be treated with immediate tamponade followed by intravascular embolization as needed.

Another complication of PCNL is perforation of the renal collecting system, which can result in ascites. In severe cases, the intraperitoneal fluid can inhibit diaphragmatic contraction and may necessitate prolonged intubation.

Finally, residual stones are common after PCNL procedures. Some surgeons perform a “second look” procedure 1 to 2 days after the primary procedure using the same access tract. Smaller residual fragments can be treated with active surveillance, ESWL, or ureteroscopy.