Non-Angled Intercostal Percutaneous Access Under Full Expiration: Safety Is Not an Issue Anymore

Ajib, Khaled; Matta, Imad; Zgheib, Joseph; Jabbour, Michel E.

doi:10.1089/end.2017.0078

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…In their article, Ajib , Matta, Zougheib, &Jabbour (2017)demonstrated that intercostal approach under full expiration is in fact safe and allows better access to the intrarenal collecting system with minimal complications. 11 Although no significant difference was observed in terms of overall complications, morbidly obese patients had the highest percentage of > Class II complications (14.29%). This was also shown in the CROES study of the influence of BMI on outcome where there was a higher rate of major complications in super obese, but overall there was no difference.…”

Section: Discussionmentioning

confidence: 80%

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

Jabbour¹,

Jabbour²,

Zgheib³

2018

UNOAJ

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Introduction: The use of percutaneous nephrolithotomy (PCNL) in obese patients with nephrolithiasis has been a subject of debate. Numerous publications have debated the pros and cons of this procedure. In order to assess the efficacy and feasibility of this technique in patients with a BMI>25 kg/m2, several factors should be studied and compared. Purpose: The purpose of this study is to prove the efficacy and safety of prone PCNL in obese patients and to compare preoperative, intraoperative and postoperative variables between obese patients and those with normal BMI. Methods: Data was collected throughout 7 years on all patients presenting for PCNL at our institution. All patients underwent prone PCNL under fluoroscopy by a single urologist and the need for subsequent procedure was studied. A total of 276 patients were grouped, after applying exclusion criteria, into 4 categories according to their BMI: Normal BMI (72), overweight (112), obese (80) and Morbidly Obese (12). Using statistical analysis data was compared among the 4 groups of BMI. Results: The risk of intraoperative related complications including pneumothorax and bleeding was the same among the 4 study groups (p=0.07). No difference was found in terms of subcostal v/s intercostal access (p=0.068). 8%, 1.79%, 8.54% and 0% of the normal, overweight, obese and morbidly obese respectively required transfusions (p=0.103). No significant difference (p=0.07) was found among the groups in overall complication rates being 12% in the Normal BMI group,16% in the overweight, 10% in the obese, and 21% in the morbidly obese. Mean operative time was 84.39, 85.45, 97.31 and 122.5 min in the normal, overweight, obese and morbidly obese respectively (p=0.01). Stone free rate was 52% in the normal BMI group, 62% in the overweight, 66% in the obese and 50% in the morbidly obese (p=0.268). Conclusion: PCNL in obese patients, BMI>25 kg/m2, was associated with a longer operative time, but with similar rate of complications, transfusion requirements and the need for subsequent procedures when compared to patients with normal BMI. This pioneer study in the Middle East establishes PCNL as safe and feasible procedure in obese patients.

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Section: Discussionmentioning

confidence: 80%

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

Jabbour¹,

Jabbour²,

Zgheib³

2018

UNOAJ

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“…Specifically, when provision of access is planned prior to lithotripsy, superior calyceal access is indicated for staghorn calculi, large upper caliceal calculi, calculi associated with ureteropelvic junction (UPJ) pathology, and large upper-ureteral calculi. 23 In these scenarios, upper pole access may necessitate an intercostal approach. An understanding of thoracic anatomy is crucial to minimize complications associated with transpleural access, which include pneumothorax, pleural effusion, urothorax, and intercostal arterial injury.…”

Section: Intercostal Accessmentioning

confidence: 99%

“…24 By accessing above the lateral half of the 12th rib during expiration, injury to the pleura can be minimized. 23 Access above the 11th rib significantly increases the risk of pleural injury, 25 and is therefore avoided in some institutions. 24…”

Section: Intercostal Accessmentioning

confidence: 99%

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Emergent Percutaneous Nephrostomy for Pyonephrosis: A Primer for the On-Call Interventional Radiologist

Florido

Herren

Pandhi

et al. 2020

Semin intervent Radiol

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Pyonephrosis is gross accumulation of pus within an obstructed renal collecting system that, if left untreated, can lead to potentially fatal septic shock. Treatment requires urgent decompression coupled with systemic antibiotics. Percutaneous nephrostomy (PCN) placement, first described in 1976 for the treatment of pyonephrosis, is now widely utilized for emergent decompression in these patients. When performed by an experienced interventional radiologist, PCN is a safe procedure with technical success rates of over 96 to 99%. This article will address the clinical presentation of pyonephrosis, and will discuss the indications, technique, complications, and outcomes of emergent PCN placement. Additionally, the expanded indications for PCN placement in nonemergent scenarios will also be described.

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Renal Mass Biopsy

Ingham

Feldman

2018

Diagnosis and Surgical Management of Renal Tumors

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Non-Angled Intercostal Percutaneous Access Under Full Expiration: Safety Is Not an Issue Anymore

Cited by 5 publications

References 14 publications

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

Emergent Percutaneous Nephrostomy for Pyonephrosis: A Primer for the On-Call Interventional Radiologist

Renal Mass Biopsy

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