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Consent: Percutaneous Nephrolithotomy

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Last updated: June 18, 2021
Revisions: 5

Last updated: June 18, 2021
Revisions: 5

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This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

A percutaneous nephrolithotomy is a common urological procedure utilised for the removal of renal calculi, typically for those >3cm in diameter, staghorn calculi, or those unsuccessfully treated by extracorporeal shockwave lithotripsy.

The kidney is accessed percutaenosuly under X-ray or ultrasound guidance and a camera is passed through. The stone(s) that need treatment are identified and then obliterated, using either a laser or lithoclast. A nephrostomy tube is then left in situ for a few days that permits the drainage of any blood or urine.

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Damage to major blood vessels during the procedure; may need suture ligation or, if severe, embolisation or nephrectomy Careful and meticulous technique, identifying major blood vessels
Damage to surrounding structures This can be either thoracic (lungs, pleura) or abdominal (bowel, liver, spleen) structures Use of X-Ray or ultrasound guidance for placement of initial guidewire
Multiple punctures required Often required in those with complex anatomy to ensure all stones removed
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential ways to Reduce Risk
Infection Infections to the renal tract can be introduced from instrument insertion Maintain an aseptic technique throughout the procedure
Haematuria Bleeding from kidney into the collecting system can occur following the procedure; this is often transient
Pain Pain from both the operation site and from the nephrostomy tube itself Regular analgesia post-operatively and the use of local anaesthesia around the puncture site
Nephrocutaneous fistula formation May occur several days after removal of the nephrostomy tube and can cause leakage of urine; fortunately, this usually spontaneously resolves
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