Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy
Int. braz. j. urol
;
35(3): 271-283, May-June 2009. ilus, tab
Article
in English
| LILACS
| ID: lil-523152
ABSTRACT
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 ANDMETHODS:
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.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Nephrostomy, Percutaneous
/
Lithotripsy
/
Kidney Calculi
Type of study:
Etiology study
/
Observational study
/
Risk factors
Limits:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
English
Journal:
Int. braz. j. urol
Journal subject:
Urology
Year:
2009
Type:
Article
Affiliation country:
United States
Institution/Affiliation country:
SUNY Downstate/US
/
Tulane Health Science Center/US
/
Tulane School of Tropical Medicine/US
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