Complications Associated with Percutaneous Nephrolithotripsy: Supra- Versus Subcostal Access
A retrospective study
Article first published online: 4 JUL 2003
Volume 44, Issue 4, pages 447–451, July 2003
How to Cite
Radecka, E., Brehmer, M., Holmgren, K. and Magnusson, A. (2003), Complications Associated with Percutaneous Nephrolithotripsy: Supra- Versus Subcostal Access. Acta Radiologica, 44: 447–451. doi: 10.1034/j.1600-0455.2003.00083.x
- Issue published online: 4 JUL 2003
- Article first published online: 4 JUL 2003
- Accepted for publication 24 February 2003.
- interventional procedure;
- percutaneous lithotripsy
Purpose: Percutaneous nephrolithotripsy is an essential procedure for treating complex urinary calculi. To achieve optimal access to a large and complicated stone, an upper calyx puncture is often preferable. However, when performing a puncture above the 12th rib there is risk of an increased number of complications. In this retrospective study, we assessed the kind and frequency of complications after sub- and supracostal punctures of the collecting system of the kidney.
Material and Methods: Between 1996 and 2001, 85 patients were treated with percutaneous nephrolithotripsy. In 63 patients a subcostal track, below the 12th rib was established. Puncture was performed under ultrasonic or fluoroscopic guidance in 61 patients and CT-guided in 2 patients. In 17 patients a supracostal puncture, above the 12th rib, was performed under CT guidance and in 5 patients with US or fluoroscopic guidance.
Result: The main difference regarding preoperative complications was the number of patients complaining of respiratory correlated pain, 7 (32%) in the supracostal puncture group compared with 3 (5%) in the subcostal puncture group. No significant difference regarding peroperative complications was found. Postoperatively, there were 2 major bleedings, one in each group, which had to be treated with arterial embolization. In the supracostal puncture group there were 2 patients with pleural effusion and 2 patients with pneumothorax.
Conclusion: The complication rate was slightly higher after supracostal puncture as compared with a subcostal approach, especially regarding respiratory correlated pain. When performing a supracostal puncture there is an increased risk that the track passes through the pleural space, which might explain the difference in the panorama of complications.