WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Ahmed Kamal Khazaal*, Yousif Salim Khalaf, Hayder I. Jawad and Ehab Jasim Mohammad

ABSTRACT

Background: PCNL is a popular minimally invasive treatment for eliminating big renal calculi. Iatrogenic injuries during PCNL can include bleeding, renal vein injury, and organ damage, but the surgery is normally safe. Improving surgical safety and results requires identifying these injuries' occurrence and kinds. This study will investigate intraoperative and postoperative iatrogenic injuries during PCNL in a multicenter Endourology setting in Iraq to improve surgical accuracy and patient safety. Methods: A retrospective multicenter study was conducted from February 2020 to February 2024, evaluating 6,278 patients who underwent PCNL. Among them, 35 cases of iatrogenic injuries were identified. Patients were monitored intraoperatively for access-related injuries, vascular injuries, ureteric and colonic injuries, tract dilation complications, and torque-related trauma. Postoperatively, patients were assessed for urinoma, pleural effusion, continuous urinary leakage, and bleeding. Results: Of the 6,278 PCNL procedures, iatrogenic injuries occurred in 35 cases (0.6%). The most common complication was tract dilatation injury (28.6%), followed by access-related injuries (20%) and bleeding (14.3%). Less frequent injuries included torque-related trauma (8.6%), continuous urinary leakage (11.4%), and urinoma (5.7%). Rare complications, such as renal vein injury, ureteric injury, colonic injury, and pleural effusion, accounted for 2.9% each. Conclusion: PCNL remains a safe and effective procedure with a low incidence of iatrogenic injuries. The majority of complications are preventable through precise surgical techniques, careful patient selection, and adherence to anatomical landmarks. Continuous refinement of surgical approaches can further minimize complications and improve patient outcomes.