Risks and Benefits of the Intercostal Approach for Percutaneous

Abstract

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

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