Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy
| Autor: | Erich K. Lang, Raju Thomas, Rodney Davis, Ivan Colon, Wellman Cheung, Erum Sethi, Ernest Rudman, Amer Hanano, Leann Myers, Alexander Kagen |
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| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: | |
| Zdroj: | International Brazilian Journal of Urology, Vol 35, Iss 3, Pp 271-283 (2009) |
| Druh dokumentu: | article |
| ISSN: | 1677-5538 1677-6119 |
| DOI: | 10.1590/S1677-55382009000300003 |
| Popis: | OBJECTIVE:The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIAL 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 arteriovenous 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. |
| Databáze: | Directory of Open Access Journals |
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