Safety and Efficacy of Supracostal Access in Percutaneous Renal Surgery
- 1 January 2008
- journal article
- research article
- Published by Mary Ann Liebert Inc in Journal of Endourology
- Vol. 22 (1), 29-34
- https://doi.org/10.1089/end.2007.0054
Abstract
Background and Purpose: During percutaneous renal surgery, subcostal access is preferred because it carries no risk of injury to either the lungs or pleura. However, in some situations, a supracostal approach may provide more direct access and achieve a more satisfactory result than the subcostal approach. In this prospective study, we evaluated the safety and efficacy of supracostal approaches in percutaneous renal surgery. Materials and Methods: Between 2004 and 2006, 30 patients underwent percutaneous renal surgery with a supracostal approach either as the sole or as a secondary access. The indications were staghorn stones, upper caliceal stones, upper ureteral stones, secondary ureteropelvic junction obstruction, disturbed lower caliceal anatomy, and high-lying kidneys. The puncture was above the eleventh rib in six procedures and above the twelfth rib in 24 procedures. All patients were examined for equal air entry on both sides of the chest, and all had chest radiography performed immediately after surgery to exclude pneumothorax or hydrothorax. Bleeding was assessed with evaluation of preoperative and postoperative hemoglobin, levels and vital signs;, urine was also examined for gross hematuria. A routine nephrostogram was obtained for all patients. Results: Supracostal was the sole access in 63.3% of patients and a secondary access in 36.7% of patients. Intraoperatively, bleeding occurred in one patient. Hydrothorax in another patient necessitated insertion of an intercostal chest drain. A renopleural fistula developed in another patient 2 days postoperatively that necessitated placement of a chest drain and Double J stent. Access in both patients with pleural complications had been above the eleventh rib. The mean drop in hemoglobin level was 0.79 ± 0.72 g/dL. Our overall stone-free rate was 88.9%. Conclusion: Supracostal access above the twelfth rib is relatively safe; however, access above the eleventh rib should be limited to necessity because a higher incidence of pleural complications can be expected. A chest radiograph should be obtained immediately postoperatively for early detection of hydrothorax or pneumothorax.Keywords
This publication has 13 references indexed in Scilit:
- Management of nephropleural fistula after supracostal percutaneous nephrolithotomyUrology, 2004
- To the Editors:Journal of Endourology, 2003
- Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomyBJU International, 2002
- CRITICAL ANALYSIS OF SUPRACOSTAL ACCESS FOR PERCUTANEOUS RENAL SURGERYJournal of Urology, 2001
- Supracostal Approach in Percutaneous Nephrolithotomy: Experience with 102 CasesJournal of Endourology, 2001
- The Supracostal Percutaneous Nephrostomy for Treatment of Staghorn and Complex Kidney StonesJournal of Endourology, 1998
- Urologist-Acquired Renal Access for Percutaneous Renal SurgeryUrology, 1998
- Percutaneous Nephrolithotomy through an Intercostal ApproachActa Radiologica, 1991
- Percutaneous extraction of urinary calculi: use of the intercostal approach.Radiology, 1985
- PERCUTANEOUS TROCAR (NEEDLE) NEPHROSTOMY IN HYDRONEPHROSISJournal of the American Medical Association, 1955