Retro-renal colon: role in percutaneous access

Sharma, Govind; Jangid, Dharmendra Kumar; Yadav, Sher Singh; Mathur, Rajendra Mohan; Tomar, Vinay

doi:10.1007/s00240-014-0733-5

Cited by 17 publications

(16 citation statements)

References 18 publications

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“…Hopper et al reported that retrorenal colon was found in 1.9 % of 500 patients who underwent abdominal CT scan in a supine position, whereas it was seen in 10 % of 90 patients in a prone position [12]. In the larger series study, retrorenal colon was detected in 2 and 6.8 % of patients in supine and prone position, respectively [13]. Despite this, a recently published meta-analysis showed that the risk of colon injury in prone or supine PNL is comparable [14].…”

Section: Discussionmentioning

confidence: 85%

“…Additional steps include total parenteral nutrition, bowel rest and intravenous broad-spectrum antibiotics (7-14 days) [4,16]. After 7-10 days, a contrast agent is given through the nephrostomy tube, and if no nephron-colonic fistula is seen, the tube may be removed [13,[17][18][19]. The ureteral double j stent is removed after 4-6 weeks [20].…”

Section: Conservativementioning

confidence: 99%

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Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

et al. 2015

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We present our experience with the largest series of colon perforation (CP) as complication of percutaneous nephrolithotomy (PNL). From January 1998 to August 2014, 22 cases that presented with PNL-related CP from seven referral centers were retrospectively reviewed. The patients with CP were evaluated in terms of probable risk factors. Peri-operative and postoperative findings, timing of diagnosis, and treatment modalities of the CP were reviewed. Of the 22 patients, previous ipsilateral renal surgery (n:2) and retrorenal colon (n:5) were the risk factors for CP. The CP was directly visualized via nephroscopy during the surgery in 3 (13.6%) and with nephrostography at the end of the procedure in 4 patients (18.2%). In two patients, perforation was realized via the passage of contrast into the colon with nephrostography on the postoperative second day. Postoperative passage of feces through the nephrostomy tube was seen in six patients. The clinical signs in 13 cases directed CP diagnosis. The confirmation of the CP was achieved with a CT scan in all the patients. The patients with extraperitoneal perforation were primarily managed conservatively. Open surgical treatment was performed in cases with intraperitoneal perforation (n:5) and those with extraperitoneal perforation resistant to conservative treatment (n:5). Meticulous evaluation of the risk factors preoperatively is the initial step in the prevention of CP. Timely diagnosis plays essential role in the management of this PNL complication. Although extraperitoneal CP may be managed conservatively, surgery is required for intraperitoneal CPs.

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Section: Discussionmentioning

confidence: 85%

Section: Conservativementioning

confidence: 99%

Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

et al. 2015

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“…Retrorenal colon is also more common in the prone position, occurring in 6.8% of patients compared with 2% in supine patients. 27,28 Across these studies the risk of colonic perforation was 0.25% and was higher for a left-sided puncture in the prone position, with only four perforations occurring in the supine position. Studies have not clearly documented what proportion of patients had prone or supine PCNLs to determine the risk of perforation in each position.…”

Section: Discussionmentioning

confidence: 93%

The risk factors associated with colonic injury during percutaneous renal stone surgery – a literature review

Burns

Nalagatla

2019

Journal of Clinical Urology

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Objective: A focused literature review was conducted of colonic injuries occurring during percutaneous nephrolithotomy (PCNL) procedures to determine the importance of patient position, identifiable risk factors and methods to avoid colonic injury. Method: A MEDLINE literature search was performed from PubMed and Scopus databases to retrieve all articles relating to colonic injuries occurring during PCNL. Incidence of colonic injury, patient management, position, side of stone and recognised risk factors were compiled for analysis. Results: Of the 35,054 PCNLs carried out, 87 colonic perforations were identified, which results in a 0.25% chance of perforation. A total of 65.5% (57/87) of colonic perforations occurred during left-hand punctures, and 54.0% (47/87) occurred in the prone position. Retrorenal colon, posterior colon, previous renal tract surgery, horseshoe kidney and mobile kidneys were the most common risk factors identified. Discussion: The risk of colonic perforation during PCNL was 0.25% across these studies. It more commonly occurred in the prone position and on the left-hand side. Only four perforations were noted to be in the supine position. A retrorenal colon is implicated as the most common identifiable risk factor. Careful preoperative work-up, planning and intraoperative use of ultrasound combined with fluoroscopy is the best method of preventing a colonic injury. Level of evidence: Not applicable for this multicentre audit.

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“…Retro-renal colon (RRC) is found in 2% patients in supine and 6.8% patients in prone position [1]. RRC is one of the most important risk factors for colon perforation during percutaneous access to the kidney [2].…”

Section: Introductionmentioning

confidence: 99%

“…RRC is one of the most important risk factors for colon perforation during percutaneous access to the kidney [2]. Sharma et al [1] estimated that there was a 65% chance of colon injury during percutaneous renal access in cases with RRC detected during computed tomography (CT) evaluation.…”

Section: Introductionmentioning

confidence: 99%

A Different and Novel Alternative (ADANA) Renal Access Technique when CT or USG Guidance Is Inadequate in Case of Retro-Renal Colon

et al. 2020

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Introduction: Computed tomography (CT) or ultrasonography (USG)-guided renal access for percutaneous nephrolithotomy (PNL) is not suitable in all cases with retro-renal colon (RRC) due to anatomical and technical restrictions. We would like to describe our novel technique that permits standard subcostal renal access with a small incision for these patients. Methods: This method was performed on adult patients with severe RRC and complex renal stones who were not suitable for renal access with CT or USG guidance. Time from skin incision to puncture needle insertion, incision length, stone-free rate (SFR), and complications were evaluated. Surgical Technique: The appropriate renal calyx for renal access was identified with retrograde pyelography. The skin closest to the identified calyx was incised and retroperitoneum visualized. The RRC was swept laterally by blunt dissection to obtain a safe puncture line. The retractors were placed to keep the colon away from the incision. Then, the puncture needle was placed over Gerota’s fascia. After this, the puncture needle was inserted into the targeted calyx under fluoroscopic guidance. The insertion of guidewire and the rest of the procedure such as dilatation and insertion of Amplatz sheath were performed under same maneuver. Results: A total of 1,348 patients were treated with PNL between January 2016 and November 2019. Our group consisted of 16 adult patients with a median age of 44.8 years (7 females and 9 males) who underwent PNL with our new access technique. SFR and clinically insignificant residual fragment (CIRF) rate were 72.5 and 14.2%, respectively. The median access time was 22.2 min (range: 15–30 min). The median skin incision length was 3.7 (range: 3.0–4.5) cm. The average skin incision length was 3.7 cm. The SFR and CIRF rate were 72.5 and 14.2%, respectively. We did not observe any complication related to our access technique. Conclusion: Our novel access technique created a safe anatomical route for standard subcostal renal access with acceptable incision length and very low complication rate.

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Retro-renal colon: role in percutaneous access

Abstract: Considering the low incidence, the sample size in our study is small. We recommend multicentric large population-based study to establish the true incidence of retrorenal colon and chances of injury to colon.

Cited by 17 publications

References 18 publications

Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

The risk factors associated with colonic injury during percutaneous renal stone surgery – a literature review

A Different and Novel Alternative (ADANA) Renal Access Technique when CT or USG Guidance Is Inadequate in Case of Retro-Renal Colon

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