Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy

OBJECTIVE:The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIAL AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0 percent), one arterio-calyceal fistula (1.0 percent) and three arteriovenous fistulae (2.7 percent) for intercostal upper pole access; two pneumothoraces (1.7 percent), one arteriovenous fistula (1.0 percent), one pseudoaneurysm (1.0 percent), one ruptured uretero-pelvic junction (1.0 percent), 4 perforated ureters (3.4 percent) for subcostal upper pole access; one hemothorax (1.6 percent), one colo-calyceal fistula (1.6 percent), one AV fistula (1.6 percent), and two perforated ureters (3.2 percent) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2 percent of the time compared with 2.4 percent with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.

Las relaciones públicas como instrumento en el control de riesgos / Public relations as instrument for risks control

Medical malpractice is analyzed from the point of view of the patient. Prevention of litigations goes beyond the ability of the provider to practice good medicine. Of utmots importance are communication with the patients, learning about and providing for their needs, and maintaining harmonuouss relations that will result in satisfaction of patients with the services which they receive