ABSTRACT
Percutaneous nephrolithotomy (PCNL) is a common procedure done for stone removal, as it is less invasive than an open procedure. But, several complications may occur. Hemothorax is a rare but severe chest complication of the supracostal puncture during PCNL. We experienced an acute hemothorax and lung collapse just after PCNL in a 66-year-old male patient with left renal stone. A chest tube was inserted for drainage and was removed after 9 days, when a chest X-ray revealed good expansion of lung.
Subject(s)
Aged , Humans , Male , Chest Tubes , Drainage , Hemothorax , Lung , Nephrostomy, Percutaneous , Pulmonary Atelectasis , Punctures , ThoraxABSTRACT
Objective To evaluate the efficacy and safety of ultrasonography-guided percutaneous nephrolithotomy(PCNL).Methods Between May 2006 and June 2008,110 patients underwent PCNL by a single urological team at our hospital.The clinical data of the patients were retrospectively reviewed.Of the cases,supracostal access(the 11th intercostal space) was made in 62 patients(supracostal group),and subcostal access was obtained in 48 patients(subcostal group).Forty-five patients in the supracostal group(45/62) and 36 of the subcostal group(36/48) received CT three dimensional reconstruction.Results The stone free rate of the supracostal group was 72.6%(45/62),while that of the subcostal group was 60.4%(29/48;?2=1.818,P=0.178).The mean operation time of the supracostal group was(78.6?5.1) min,while that of the subcostal group was(102.4?7.1) min(t=-20.454,P=0.000).There was one patient in each group received blood transfusion.One patient in the supracostal group had pneumothorax and recovered uneventfully by conservative treatments.Conclusion Ultrasonography-guided PCNL via the supracostal approach is effective and safe with short operation time.
ABSTRACT
PURPOSE: The supracostal access for percutanous nephrolithotomy (PCNL) is a more useful approach in certain situations according to the position of the kidney, location of the calculi, or configuration of the collecting system. We attempted to assess the availability of supracostal approach based on the experience with supracostal approach in treating the complex renal stone and upper ureteral stones at our institution. MATERIALS AND METHODS: The medical records of 26 patients who underwent sup racostal PCNL procedure, between April 1996 and January 2001 were reviewed retrospectively. Under the general anesthesia, 11th-12th intercostal space was selected for the puncture site. Before the needle was passed between the ribs, the lung was deflated completely to prevent thoracic injury. RESULTS: Mean operating time and hospital stay were 81 minutes and 6.7 days, respectively. The stone-free rate after supracostal PCNL was 73% (19 patients). Extra corporeal shock wave lithotripsy (ESWL) was needed to treat residual stones in 7 patients (26%). After supracostal PCNL followed by ESWL, the stone-free rate rose to 88% (23 patients). Three patients (11%) developed pleural effusion postoperatively, one of whom had chest tube placed, the others improved with conservative management. Except for the pleural effusion, there were no complications such as atelectasis, pnemothorax, hemothorax, or injury to the liver or spleen. CONCLUSIONS: Since the complication rate can be kept to minimum with strict precaution, there is no reason to hesitate supracosatal PCNL, when upper pole punc ture is needed and the desired puncture site is above 12th rib.