Minimally invasive percutaneous nephrolithotomy is a new technology developed in the last 20 years for the treatment of kidney stones, the application of this technology has enabled more and more patients with complicated kidney stones to avoid the pain of surgery, but not all patients with kidney stones are suitable for it, it also has certain contraindications, mainly including the following cases: 1.
1. Systemic bleeding disorders that have not been corrected.
2. Severe kyphosis of the spine that cannot be performed in prone position. Zheng Junhong, Department of Urology, Second Affiliated Hospital of Shantou University Medical College
3. Severe cardiopulmonary insufficiency, unable to tolerate surgery.
4. Extremely obese, unable to establish percutaneous renal access.
Although percutaneous nephrolithotomy is a minimally invasive procedure, it requires direct puncture through the kidney, which is an organ full of blood vessels and surrounded by some important organs, so there are certain risks involved in the procedure, which patients and their families must understand. The main aspects are as follows.
1. If the patient has congenital malrotation of the kidney or excessive obesity, it may increase the risk of intraoperative injury to the colon, duodenum, liver and spleen, with an incidence of about 0.2%. If the patient is found to have splenomegaly before surgery, it is also a contraindication to left kidney puncture.
2. Late intraoperative or postoperative hemorrhage. The incidence of postoperative hemorrhage due to pseudoaneurysm formation or arteriovenous fistula is 1%. Interventional embolization or open surgery is required when bleeding is difficult to control. The rate of blood transfusion in early surgery was as high as 52%, but has decreased to about 10% in recent years.
3. Infection and its complications. The chance of septic septic shock is 0.25-1% when bacteria enter the bloodstream during surgery. If the patient has an antler-shaped stone, postoperative infection and fever can be as high as 25%.
4. Efficacy: The efficacy of minimally invasive percutaneous nephrolithotomy on different renal stones varies. For infrarenal calcium stones, the stone removal rate is 91%, which is significantly higher than that of extracorporeal lithotripsy (61%), for deerstalker stones, the stone removal rate is 60-92%, the re-treatment rate (second stone removal) is 21-80%, and the stone residual rate is 16%.