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

Gupta, Ramesh K.; Kumar, Anant; Kapoor, Rakesh; Srivastava, Aneesh; Mandhani, Anil

doi:10.1046/j.1464-410x.2002.03051.x

Cited by 132 publications

(98 citation statements)

References 13 publications

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“…Upper pole access can be achieved via the supracostal and infracostal approaches. Due to the anatomy of the kidney, pulmonary complications are more common with the supracostal approach (8,13). We previously reported 170 supracostal PCNL compared with 294 infracostal PCNL.…”

Section: Commentsmentioning

confidence: 99%

“…In uncomplicated PCNL where there is no significant Clinical Urolo�� Clinical Urolo�� doi: 10.1590/S1677-55382010000200006 extravasation, significant bleeding, or any need for a second nephroscopy, the placement of the nephrostomy tube may not be necessary (tubeless PCNL) (1)(2)(3)(4). In specific situations of PCNL, a supracostal renal approach is necessary (5)(6)(7)(8). Pulmonary complication is more common with this approach due to the anatomy of the kidney.…”

Section: Introductionmentioning

confidence: 99%

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Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

Jun-Ou

Lojanapiwat

2010

Int. braz j urol.

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Introduction: Tubeless percutaneous nephrolithotomy (PCNL) in selected patients has been found to be safe and can reduce postoperative discomfort without increasing complications. The challenges of tubeless PCNL via supracostal access are inadequate drainage and postoperative bleeding, conditions that may increase pulmonary complications. We compare the efficacy and safety of the tubeless supracostal versus the standard supracostal PCNL. Materials and Methods: Supracostal PCNL with one percutaneous renal access, no significant bleeding, extravasation and residual stone was performed in 95 patients. Of these, 43 were tubeless PCNL (Group-I) and 52 were PCNL with standard routine postoperative nephrostomy tube (Group-II). In group-I, PCNL was done by the standard supracostal technique with the placement of a postoperative external ureteral catheter for 48 hours. The operative time, success rate, hospital stay and ensuing complications were compared between group-I and group-II. Results: Patients in the tubeless PCNL group (Group-I) were 90.7% stone -free while those with standard routine postoperative nephrostomy tube(Group-II) were 84.6% stone -free. Additionally, stone fragments of less than 4 mm in diameter were found in 9.3% of patients in group-I and 25.4% in group-II. The success rate, hematocrit change and complication were not significantly different between both groups. The analgesic requirement, operative time and hospital stay were all significantly less in the tubeless supracostal group (Group-I). None of group I and only one patient of group II needed intercostal drainage. Conclusion: Tubeless supracostal percutaneous nephrolithotomy in selected patients is effective with acceptable complications. This technique offers the advantage of lower analgesic requirement, shorter operative time and hospital stay. The pulmonary complication is the same as the standard supracostal percutaneous nephrolithotomy.

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Section: Commentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

Jun-Ou

Lojanapiwat

2010

Int. braz j urol.

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“…The drawback of supracostal punctures is an increased incidence of intrathoracic complications as well as a higher rate of spleen and hepatic injury. [11][12][13] The use of supra twelfth rib punctures, perhaps reflecting the small throughput in a number of hospitals, was limited to only 6% of cases and none of whom had any complications.…”

Section: Complicationsmentioning

confidence: 99%

Contemporary Practice of Percutaneous Nephrolithotomy: Review of Practice in a Single Region of the UK

Srirangam

Darling

Stopford

et al. 2008

annals

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Ann R Coll Surg Engl 2008; 90: 40-44 40Percutaneous nephrolithotomy (PCNL) has become the mainstay of treatment for large renal calculi over the past 30 years since Fernstrom and Johansson first removed a renal calculus through a nephrostomy tract in 1976. 1 The practice of PCNL, having been refined over time, continues to evolve and has largely replaced open stone surgery for the treatment of complex upper tract stones unsuitable for extracorporeal shockwave lithotripsy (ESWL) or ureteroscopy. This has been aided by advances in technology and equipment resulting in stone removal with less morbidity, shorter convalescence, and reduced cost compared with open surgery. 2,3 Excellent outcomes have been reported following PCNL with stone-free rates approaching 95%. Nevertheless, most published series of PCNL are from single centres with a dedicated sub-specialist interest in stone management.These represent optimum results achievable and may not reflect outcomes of everyday practice in non-specialised units. The aim of the study was to analyse the current practice of PCNL in our region. Patients and MethodsThe region comprises 12 participating hospital trusts. Of these, two were tertiary referral centres with a recognised expertise in stone management, while the rest (10) comprised district general hospitals (secondary centres) providing a range of urological interventions. All patients undergoing a PCNL procedure in 2002 were identified using theatre records and medical records scrutinised retrospectively. In trusts performing more than 20 procedures

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“…Contemporary studies demonstrate improved stone-free rates with a low incidence of pleural injuries with upper pole access. 20,28 As such, we feel that the risk of pleural injury should not impede selection of upper calyceal access if deemed appropriate to maximize stone clearance. Although a multiple-access approach is advocated by some to avoid a supracostal puncture, its use has been found to be associated with an increase in bleeding complications.…”

Section: Preventing Splenic Injurymentioning

confidence: 99%

“…For PCNL, a supracostal approach is preferred for the treatment of upper pole stones, staghorn or complex calculi, and stones in the proximal ureter 20 ; however, the risk for visceral injury is greater for tracts placed above the 12th rib. To assess the safety of a supracostal approach, Hopper and Yakes evaluated the potential course of a percutaneous access tract on CT scans obtained during full inspiration and expiration, finding that in the prone position, an 11th to 12th intercostal approach would not be expected to puncture the liver or spleen during expiration.…”

Section: Preventing Splenic Injurymentioning

confidence: 99%

Splenic Injury During Percutaneous Nephrolithotomy: A Case Report with Novel Management Technique

Desai

Jain

Benway

et al. 2010

Journal of Endourology

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We describe a case of a splenic injury caused by a transsplenic percutaneous nephrostomy tract. The case was completed without incident and the nephrostomy tube was noted to traverse the spleen on routine postoperative imaging. This rare complication was managed by deposition of Gelfoam Ò pledgets along the transsplenic nephrostomy tract and placement of a ureteral stent. This novel management technique has not been previously described in the literature and was successful in the conservative treatment of the uncommon complication of splenic injury during percutaneous nephrolithotomy.

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

Abstract: Objective To prospectively evaluate the safety and efficacy of the supracostal approach for percutaneous nephrolithotomy (PCNL), as it is usually avoided because of concerns about potential chest complications. Patients and methods

Cited by 132 publications

References 13 publications

Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

Contemporary Practice of Percutaneous Nephrolithotomy: Review of Practice in a Single Region of the UK

Splenic Injury During Percutaneous Nephrolithotomy: A Case Report with Novel Management Technique

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