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- Title
Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access. A retrospective study.
- Authors
Radecka, E.; Brehmer, M.; Holmgren, K.; Magnusson, A.
- Abstract
<bold>Purpose: </bold>Percutaneous nephrolithotripsy is an essential procedure for treating complex urinary calculi. To achieve optimal access to a large and complicated stone, an upper calyx puncture is often preferable. However, when performing a puncture above the 12th rib there is risk of an increased number of complications. In this retrospective study, we assessed the kind and frequency of complications after sub- and supracostal punctures of the collecting system of the kidney.<bold>Material and Methods: </bold>Between 1996 and 2001, 85 patients were treated with percutaneous nephrolithotripsy. In 63 patients a subcostal track, below the 12th rib was established. Puncture was performed under ultrasonic or fluoroscopic guidance in 61 patients and CT-guided in 2 patients. In 17 patients a supracostal puncture, above the 12th rib, was performed under CT guidance and in 5 patients with US or fluoroscopic guidance.<bold>Result: </bold>The main difference regarding preoperative complications was the number of patients complaining of respiratory correlated pain, 7 (32%) in the supracostal puncture group compared with 3 (5%) in the subcostal puncture group. No significant difference regarding peroperative complications was found. Postoperatively, there were 2 major bleedings, one in each group, which had to be treated with arterial embolization. In the supracostal puncture group there were 2 patients with pleural effusion and 2 patients with pneumothorax.<bold>Conclusion: </bold>The complication rate was slightly higher after supracostal puncture as compared with a subcostal approach, especially regarding respiratory correlated pain. When performing a supracostal puncture there is an increased risk that the track passes through the pleural space, which might explain the difference in the panorama of complications.
- Subjects
LITHOTRIPSY; URINARY calculi; KIDNEY stones; COMPARATIVE studies; COMPUTED tomography; FLUOROSCOPY; HEMORRHAGE; RESEARCH methodology; MEDICAL cooperation; PLEURAL effusions; PNEUMOTHORAX; RESEARCH; RIB cage; OPERATIVE surgery; ULTRASONIC imaging; URINARY diversion; EVALUATION research; RETROSPECTIVE studies
- Publication
Acta Radiologica, 2003, Vol 44, Issue 4, p447
- ISSN
0284-1851
- Publication type
journal article
- DOI
10.1034/j.1600-0455.2003.00083.x