Percutaneous extraction of urinary calculi: use of the intercostal approach.

Abstract

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.

Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy

“…The optimal access for the staghorn, large upper calyceal and complex renal stone burden is through the upper pole posterior calyx, which at times is best accomplished by supracostal puncture [1]. The supracostal puncture is usually a concern because of the potential complications of pneumothorax, hydrothorax and lung injury [2][3][4]; hydrothorax has been reported in 6-32% of procedures [5][6][7][8]. We prospectively evaluated the safety and efficacy of the supracostal approach for the percutaneous removal of staghorn and complex renal stones.…”

Middle calyx access in complete supine percutaneous nephrolithotomy

“…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. The complete supine PCNL is suitable for all patients with upper urinary tract stones and has a shorter operative time than prone PCNL.…”

“…[11][12][13][14]21 It may result from easy access to the middle calyx, proper angle between the middle calyx tract and long axis of the kidney, optimal alignment of this access with uretero-pelvic junction and easy access to the renal pelvis and upper ureter for removal of stones. 4,19 Traditionally, upper and lower calices are used for access. The acute angle between lower calyx tract and long axis of the kidney may difficulty in some cases.…”

“…[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.…”

Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

“…The rate of pleural complications ranges from 0 to 37%. Of these, however, only a minority (0 to 8%) require treatment with placement of a chest tube (48)(49)(50)(51). Nevertheless, supracostal puncture undoubtedly presents increased morbidity for the patient compared to an infracostal approach, and the authors recommend supracostal access only when absolutely necessary.…”