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Risks and Benefits of the Intercostal Approach for Percutaneous

By Erich K. Lang, Raju Thomas, Rodney Davis, Ivan Colon, Wellman Cheung, Erum Sethi, Amer Hanano, Leann Myers and Er Kagen


Objective: The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus sub-costal access route for percutaneous nephrolithotripsy. Materials and Methods: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. Results: Major complications included one pneumothorax (1.0%), one arterio-calyceal fistula (1.0%) and three arteriove-nous fistulae (2.7%) for intercostal upper pole access; two pneumothoraces (1.7%), one arteriovenous fistula (1.0%), one pseudoaneurysm (1.0%), one ruptured uretero-pelvic junction (1.0%), 4 perforated ureters (3.4%) for subcostal upper pole access; one hemothorax (1.6%), one colo-calyceal fistula (1.6%), one AV fistula (1.6%), and two perforated ureters (3.2%) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2 % of the time compared with 2.4 % with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. Conclusion: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion. Key words: kidney; calculi; lithotripsy; nephrostomy, percutaneous; thorax; complications Int Braz J Urol. 2009; 35: 271-8

Year: 2016
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