1691 RISK FACTORS FOR THORACIC COMPLICATIONS IN PERCUTANEOUS ANTEROGRADE NEPHROSCOPY

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II)1 Apr 20131691 RISK FACTORS FOR THORACIC COMPLICATIONS IN PERCUTANEOUS ANTEROGRADE NEPHROSCOPY Jonathan J Melquist, Kevin T Gioia, Deirdre Connolly, Joseph Caputo, Merrit Debartolo, and David Schulsinger Jonathan J MelquistJonathan J Melquist Stony Brook, NY More articles by this author , Kevin T GioiaKevin T Gioia Stony Brook, NY More articles by this author , Deirdre ConnollyDeirdre Connolly Stony Brook, NY More articles by this author , Joseph CaputoJoseph Caputo Stony Brook, NY More articles by this author , Merrit DebartoloMerrit Debartolo Stony Brook, NY More articles by this author , and David SchulsingerDavid Schulsinger Stony Brook, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3053AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous renal access is commonly utilized for the treatment of calculi (PCNL) as well as ureteropelvic junction obstruction (endopyelotomy). While it is generally regarded as a safe procedure in experienced hands, the possibility of thoracic complications is understood. Nonetheless, there is a paucity of data in the literature regarding this complication. We present our 5 year experience. METHODS We retrospectively reviewed the charts of 251 consecutive cases of percutaneous nephroscopy for stone extraction or endopyelotomy at a single academic center from 2007 to 2012. Percutaneous access was gained by interventional radiologists using traditional methods typically one day prior to percutaneous nephroscopy. Thoracic complications were defined as a hydro-, hemo-, or pneumothorax or pleural effusion. Pre- and post-operative chest radiographs (CXR) were reviewed. A non-contrast CT of the chest was performed in all patients with suspicious post-operative CXR. Patients were stratified according to Clavien Grading System. RESULTS A total of 20.3% (51/251) patients developed interval effusions on post-operative CXR. Tube thoracostomy drainage was indicated in 4.8% (12/251). Effusions were recognized promptly when they became symptomatic, on average 4.2 hours from Surgery. A majority of cases were associated with staghorn calculi (58.3%). There appears to be a strong correlation between approach of the kidney and hydropneumothoraces. Of those patients who received tube thoracostomies, 83.3% had percutaneous access above the 12th rib and 58.3% approached the upper pole of the kidney. CONCLUSIONS Effusions requiring no intervention occur at a significant rate (15.5%) while hydropneumothoraces occur much less frequently (4.8%) for those receiving percutaneous nephroscopy. Several factors are associated with these thoracic complications. We conclude that post-operative CXR should be performed on all patients receiving the procedure. The urologic surgeon must remain ever vigilant about thoracic complications of percutaneous renal surgery. Thoracic Complications Pleural Effusion Requiring No Intervention Hydro-, Hemo-, Pneumothorax Requiring Tube Thoracostomy Incidence 39/251 (15.5%) 12/251 (4.8%) Clavien Grade 1-2 3-4 Demographics: Height (cm) 166±9 158±5 BMI 27.0±5.9 27.4±3.9 Indication: PCNL 35/39 (89.7%) 12/12 (100%) Endopyelotomy 4/39 (10.3%) 0/11 (0%) PCNL Metrics: Accesses (#) 1.10±0.31 1.25±0.45 Stone Size (cm2) 2.19±1.47 10.4±11.9 Staghorn 15/39 (38.5%) 7/12 (58.3%) Skin-to-Stone Distance 7.85±2.35 6.5±0.4 Percutaneous Access: Below 12th rib 10/39 (25.6%) 1/12 (8.3%) 11th intercostal Space 18/39 (46.2%) 9/12 (75.0%) 10th intercostal Space 4/39 (10.3%) 0/12 (0%) 9th intercostal Space 0/39 (0%) 1/12 (8.3%) Upper Pole Access 29/39 (74.4%) 7/12 (58.3%) Middle Pole Access 5/39 (12.8%) 5/12 (41.7%) Lower Pole Access 5/39 (12.8) 1/12 (8.3%) © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e695-e696 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan J Melquist Stony Brook, NY More articles by this author Kevin T Gioia Stony Brook, NY More articles by this author Deirdre Connolly Stony Brook, NY More articles by this author Joseph Caputo Stony Brook, NY More articles by this author Merrit Debartolo Stony Brook, NY More articles by this author David Schulsinger Stony Brook, NY More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...