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Komplikationen bei der perkutanen Steinbehandlung

Complications in percutaneous lithotomy

  • Leitthema
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Zusammenfassung

Hintergrund

Die perkutane Nephrolithotomie stellt in der Behandlung größerer Nierensteine den Goldstandard der Therapie dar. Einzelne Schritte des Eingriffs können mit schwerwiegenden Komplikationen behaftet sein, deren Erkennung und Behandlung von größter Wichtigkeit bei der optimalen Patientenversorgung sind.

Ziel der Arbeit

Es werden die wichtigsten Schritte des Eingriffs und mögliche Komplikationen sowie Strategien zur Erkennung und Behandlung derselben dargestellt.

Material und Methoden

Die Arbeit berücksichtigt Übersichtsarbeiten mit der Analyse großer Patientenkollektive und Darstellung einzelner, seltener Komplikationen mit Lösungswegen.

Ergebnisse

Sorgfältige präoperative Diagnostik und Indikationsstellung sind essentiell für die sichere Durchführung einer perkutanen Steintherapie. Die komplikationsträchtigsten Operationsschritte sind die Punktion des Nierenbeckenkelchsystems und die Dilatation des Zugangsweges. Die häufigste Komplikation stellen Blutungen dar, gefolgt von infektiologischen Problemen. Die Möglichkeit einer notfallmäßigen radiologischen interventionellen Versorgung ist ein wichtiges Sicherheitsnetz zur Durchführung des Eingriffs und verhindert die operative Versorgung von Blutungskomplikationen mit möglichem Organverlust in den meisten Fällen.

Schlussfolgerungen

Die perkutane Nephrolithotomie stellt in der Hand eines Experten eine sichere und effektive Steintherapie dar. Eine optimale Planung und exakte Punktion stellen die wichtigsten Eckpfeiler zur Vermeidung schwerwiegender Komplikationen dar.

Abstract

Background

Percutaneous lithotomy is the gold standard in the treatment of large kidney stones. Several steps of the operation might cause severe complications. Safe procedures depend on careful planning, accurate performance, recognition of problems and knowledge of how to handle them.

Objectives

Relevant steps of percutaneous stone treatment with possible complications and their management are presented.

Materials and methods

Current topics in percutaneous stone treatment taking into consideration the relevant literature are discussed. Furthermore, rare complications and strategies for safe management are presented.

Results

Careful planning and adequate preoperative diagnostic workup are essential for safe procedures. Puncture of the renal calyceal system and tract dilation might lead to severe complications. Bleeding and infectious complications are the most common problems. Availability of interventional radiology provides ideal emergency treatment in case of severe bleeding and helps to avoid surgical revision with high risk of organ loss.

Conclusions

Percutaneous stone treatment is a safe and effective therapy in an experienced physician’s hands. Careful planning and accurate performance help to avoid severe complications.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Zwischen der Universitätsmedizin Mannheim und der Fa. Siemens besteht ein Kooperationsvertrag zur Entwicklung des Eingriffstischs für das Uro Dyna-CT. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    M. Ritter, M.-C. Rassweiler & M.S. Michel

Authors
  1. M. Ritter
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  2. M.-C. Rassweiler
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  3. M.S. Michel
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Corresponding author

Correspondence to M. Ritter.

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M. Ritter und M.-C. Rassweiler haben gleichberechtigte Autorenschaften.

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Ritter, M., Rassweiler, MC. & Michel, M. Komplikationen bei der perkutanen Steinbehandlung. Urologe 53, 1011–1016 (2014). https://doi.org/10.1007/s00120-014-3503-7

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  • DOI: https://doi.org/10.1007/s00120-014-3503-7

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