Complications Associated with Percutaneous Nephrolithotripsy: Supra- Versus Subcostal Access. A retrospective study

Radecka, Eva; Brehmer, Marianne; Holmgren, Klas; Magnusson, Anders

doi:10.1034/j.1600-0455.2003.00083.x

Cited by 37 publications

(29 citation statements)

References 14 publications

(26 reference statements)

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“…US is the used most commonly tool for guidance, with success rates of 88%-99% and complication rates of 4%-8% (10,11). US-guidance is effective and radiation-free; it also demonstrates the intrarenal arteries, helping operators avoid vascular injury (12).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotripsy: C-arm CT with 3D virtual navigation in non-dilated renal collecting systems

Jiao

Zhan-li²,

Sun

et al. 2018

Diagn Interv Radiol

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T he establishment of a percutaneous tract into the renal collecting system is important and requires imaging supervision during percutaneous nephrolithotomy (PCNL) (1, 2). Unlike percutaneous nephrostomy for patients with hydronephrosis, if percutaneous stone removal is planned, the puncture should be performed in a calyx with possible access to the stone. Montvilas et al. (3) demonstrated that ultrasonography (US)-guided techniques yield lower technical success in patients with non-dilated than in those with dilated collecting systems (82% vs. 98.2%). Furthermore, renal anomalies and scoliosis make needle access more challenging and necessitate puncture planning and control. The syngo iGuide navigation system (Siemens Healthcare) is a three-dimensional (3D) virtual needle tracking system which helps predict and observe the needle trajectory, facilitating real-time puncture to the target (4-7). We report our experience of percutaneous tract establishment for patients with non-dilated renal collecting systems after failed US-guided attempts. Methods Patient selectionThis retrospective study was approved by our Institutional Review Board and informed consent was waived. Between May 2014 and May 2015, of 442 patients with non-dilated renal collecting systems who required PCNL access in two urology surgery departments at our hospital, routine US-guided nephrostomy attempts failed in 33 patients. Those 33 patients (19 males, 14 females; mean age, 60.1±11.8 years) with non-dilated renal collecting systems underwent C-arm computed tomography (CT) with 3D virtual navigation system-guided establishment of PCNL access. A collecting system was identified as non-dilated if no calyceal dilatation was observed on US. All cases had previously failed under US-guidance. The mean body mass index (BMI) was 24.7±4.5 kg/m 2 (range, 17. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the clinical superiority of using C-arm computed tomography (CT) to establish percutaneous nephrolithotripsy (PCNL) access for patients with non-dilated renal collecting systems. METHODSFrom May 2014 to May 2015, 33 patients underwent C-arm CT-guided puncture to establish PCNL access after failed attempts of ultrasonography-guided nephrostomy. Technical success, procedure details, radiation exposure, complications, and stone-free rate were recorded. RESULTSThe technical success rate was 97% (32/33) with a mean puncture score of 4.5/5. Mean puncture, dilation, and fragmentation times were 17.9±6.0, 12.6±3.9, and 33.1±8.8 minutes, respectively. Mean radiation exposure was 4.8±2.1 mSv without serious complications. Stone-free rate was 93.8%. CONCLUSIONC-arm CT is a useful tool to establish PCNL access, particularly in cases of upper pole access or complicated anatomy.You may cite this article as: Jiao D, Zhang Z, Sun Z, Wang Y, Han X. Percutaneous nephrolithotripsy: C-arm CT with 3D virtual navigation in non-dilated renal collecting systems. Diagn Interv Radiol 2018; 24: 17-22.

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Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotripsy: C-arm CT with 3D virtual navigation in non-dilated renal collecting systems

Jiao

Zhan-li²,

Sun

et al. 2018

Diagn Interv Radiol

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“…11 A single percutaneous tract is sufficient during lower calyx access to remove a single lower calyx stone. But complete removal of complex or multiple lower calyx stones may be difficult by single lower calyx tract, 11,12,18 therefore upper calyx access is beneficial in these cases. 12 Although Li and colleagues 13 reported their experiences in PCNL with the middle calyx puncture, middle calyx has been underused for access in comparison with upper calyx and lower calyx, especially in the supine position.…”

Section: Discussionmentioning

confidence: 99%

“…12 Although Li and colleagues 13 reported their experiences in PCNL with the middle calyx puncture, middle calyx has been underused for access in comparison with upper calyx and lower calyx, especially in the supine position. 11,12,[14][15][16][17][18]21 Middle calyx access provides a suitable removal of stones, especially upper ureteral stones, due to proper alignment with the uretero-pelvic junction. 4,19 We used the complete supine position in all PCNLs.…”

Section: Discussionmentioning

confidence: 99%

“…It may lead to increased operative time, incomplete removal of stones and the need for additional access or subsequent ESWL in complex lower calyx stones. 5,11,12,18 Middle calyx access has been underused in PCNL, especially in the supine position. [11][12][13][14][15][16][17][18] Whereas middle calyx seems appropriate to access stones in the upper tract.…”

Section: Introductionmentioning

confidence: 99%

“…5,11,12,18 Middle calyx access has been underused in PCNL, especially in the supine position. [11][12][13][14][15][16][17][18] Whereas middle calyx seems appropriate to access stones in the upper tract. 13,19 In this non-randomized single-surgeon study, we compared the safety and efficacy outcomes between middle calyx and lower calyx accesses in patients with complete supine PCNL.…”

Section: Introductionmentioning

confidence: 99%

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Middle calyx access in complete supine percutaneous nephrolithotomy

Falahatkar

Kazemnezhad

Moghaddam

et al. 2013

CUAJ

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Background: Middle calyx access has been underused in percutaneous nephrolithotomy (PCNL), especially in the supine position. We compared the safety and efficacy outcomes between middle calyx and lower calyx accesses in the complete supine PCNL in a non-randomized single-surgeon clinical study. Methods: Between February 2008 and October 2011, 170 patients underwent posterior subcostal single tract complete supine PCNL with one-shot dilation and middle calyx (n = 48) and lower calyx (n = 122) accesses. Stone location and surgeon decision determined target calyx for access. Inclusion criteria were pelvis stones, staghorn stones and multiple location stones. Exclusion criteria were renal anomalies, only upper calyx stones, only middle calyx stones and only lower calyx stones. Important parameters were compared between the two groups. A p value of <0.05 was considered significant. Results: Two groups were similar in important patient-and stonerelated parameters. Mean operative time (60.7 minutes), mean postoperative hospital stay (1.84 days) and mean hemoglobin drop (0.67 g/dL) in the middle calyx group were significantly lesser than in the lower calyx group (80.1 minutes, 2.19 days, 1.36 g/dL). The middle calyx group (89.6%; 79.6%) had a higher stone-free rate (p = 0.054) and efficiency quotient than the lower calyx group (76.2%; 61.6%). In the middle calyx group (10.4%; 2.1%), complication and transfusion rates were lesser (p > 0.05) than lower calyx group (14.8%; 7.4%). No significant difference (p = 0.40) was seen between two groups using the modified Clavien classification of complications. Interpretation: Middle calyx can be an optimal access in PCNL with the complete supine position for many of upper urinary tract stones due to its superior outcomes.

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