Percutaneous endoscopic surgery for the treatment of upper urinary tact stone or stricture has proved less invasive, reliable and safe with results comparable to open surgery. Because this contains many procedures, however, one can expect
complicastions
at some extents.
Between 1987 and 1994, 410 percutaneous endoscopic procedures-PNL (330 cases), endopyelotomy (40 cases), endoinfundibulotomy (24 cases), endoureterotomy (10 cases), nephropexy (6 cases) -were performed by three operators in one hospital. The
incidence
of complication was evaluated and compared statistically.
Ovderall complication rates 23.6% and there was no mortality. Bleeding necessitating transfusion (7.6%) and fever (7.1%) were the most frequent complications. Other complications included renal pelvis or ureteral perforation (6.8%), paralytic
ileus
(2.9%), sepsis (0.7%), pneumothorax (0.7%), stent migration (0.7%), atelectasis (0.2%), ureteral stricture (0.2%), colon perforation (0.2%). Surgical interventions for the management of complication included nephrectomy (2 cases) for uncontrolled
bleeding, and open repair for colon perforation (1 case). Renal artery emboliszation stopped the delayed bleeding in one case. Data on complications occurring before and after the first 50 cases indicated a statistically significant decrease in
complications (p<0.005).
These complications could be attributed to inexperience, improper technique, underlying pathologic conditions, and anatomic variants. As might be expected, the complication rate was much lower on later cases according to the increasing experience
and
improved technique. Based on our accurmulated experience, the experience with more than 50 procedures could be needed to minimize complications.
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