الفهرس 
Surgical anatomy of the kidneyOnly 14 pages are availabe for public view
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Abstract
PNL is a common procedure for management of most renal stones.
Significant complications in PNL can be divided into intraoperative complications and postoperative complications.
intraoperative complications are generally attributable to Incorrect patient selection , the lack of adequate equipment and technical errors.
Positioning related complications may occur as cardiovascular complications, brachial plexus damage, shoulder dislocation, cervical spine injury, other forms of peripheral nerve injury, and peripheral vascular occlusion can occur with PNL. It is essential that appropriate positioning and padding be employed to prevent these complications.
Hemorrhage is the most frequent complication of PNL. Excessive bleeding can occur during needle passage or tract dilatation and its incidence increase with multiple puncture. Severe bleeding arises from the segmental arteries rather than from the smaller intrarenal vessels. The most common cause of bleeding from these vessels is development of AVF and pseudoaneurysm.
Intraoperative bleeding can be managed firstly by terminate the procedure and place a nephrostomy tube and Clamp it, If bleeding does not stop council tip catheter and balloon insufflation, If persistent bleeding renal angiography and superselective embolization.
Injury to renal pelvis, ureter, extravasation and migration of stone fragments may occur during PNL.
Injury to the liver and spleen during PNL is very rare but the incidence may increase in cases of hepatomegaly or spleenomegaly. Colonic perforation may occur also during PNL in less than 1%.
Chest complications as pneumothorax and/or hydrothorax may occur during PNL. The incidence of intrathoracic complications increases to 23.1% versus 1.5% to 12% with above–12th rib approach and 0.5% for subcostal access. If a small effusion is recognized, it may be tapped with relative ease with the patient still under anesthesia. If the effusion is larger or contains bloody fluid, a thoracostomy tube can be easily placed with the patient still prone and under anesthesia.
Damage secondary to energy sources may occur during PNL perforation of the collecting system and bleeding are common complications of electrohydrolic Lithotripsy (EHL).
Intraoperative hypothermia and fluid overload may observed dring PNL.
Perinephric haematoma is common complication of PNL. The overall incidence of localized and extensive hematomas is 27% and 3.5%, which usually managed conservativly.
Infection may occur post PNL. The incidence from 0.25-1.5% so, it is advised that all patients undergoing percutaneous procedures have urine cultures preoperatively with the administration of an appropriate antibiotic.
Deep venous thrombosis and pulmonary embolism may occur post PNL. The incidence of deep venous thrombosis after percutaneous renal surgery is 1 to 3%.
Infundibular stenosis is a complication of PNL. Infundibular stenosis is associated with prolonged operative time, a large stone burden requiring multiple removal procedures and extended postoperative nephrostomy tube drainage.
Nephrocutaneous fistula may occur post PNL due to prolonged postoperative drainage from the nephrostomy tract. fixation of Double-J stent is sufficient for management of fistula.
Biliary complications may occur post PNL as biliary leakage due to necrosis of the biliary tree and duodenal perforation following PNL. Broad range antibiotics therapy should systematically be given to avoid further septic complications.
To avoid the complications associated with PNL and to ensure optimum outcomes for patients, urologists must consider a number of factors when planning or performing PNL. Therefore, training and experience of the urologist are critical, as is careful patient selection, accurate positioning, and use of the best available instruments.