|
|
|
| Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy |
Pankaj N. Maheshwari*( ),Amandeep Arora,Mahesh S. Sane,Vivek Jadhao
|
| Department of Urology, Fortis Hospital Mulund, Mumbai, India |
|
|
|
|
Abstract Objective: To report our experience with supracostal percutaneous nephrolithotomy (SC-PNL) and evaluate factors which could predict the risk of hydrothorax following SC-PNL.
Methods: We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019. Patients were assessed for demographic characteristics, indication for the supracostal access, level of supracostal access, anatomy of the kidney (normal or malrotated), site of the puncture in relation to the mid-scapular line (medial or lateral), and whether another subcostal tract for stone clearance was required or not. Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access. In addition, a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL.
Results: Of the 347 patients with SC-PNL, 248 (71.5%) underwent a supra-12th rib approach, while the rest needed a supra-11th (n=85; 24.5%) or a supra-10th (n=14; 4.0%) rib tract. Overall, 17 (4.9%) patients developed a hydrothorax, while an intercostal-drain was required in seven of these 17 patients for 48 h. None of the patients with a supra-12th rib puncture required an intercostal-drain. More than a third of the patients with a supra-10th puncture developed a hydrothorax (35.7%) and all of them required an intercostal drain. Factors such as anteriorly malrotated kidney (odds ratio [OR]=2.722; 95% confidence interval [CI]=1.042-5.617, p=0.03), puncture medial to the mid-scapular line (OR=1.669; CI=0.542-1.578, p=0.03), and an access higher than the supra-12th level (OR=5.265; CI=1.292-9.342, p<0.001) proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis.
Conclusion: Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low. Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.
|
|
Received: 22 June 2020
Available online: 20 July 2022
|
|
Corresponding Authors:
Pankaj N. Maheshwari
E-mail: dr.maheshwaripn@gmail.com
|
|
|
|
|
Anatomical relations of the parietal pleura in both phases of respiration. It also shows that a puncture lateral to the mid-scapular line (red arrow) would miss the parietal pleura in expiration.
|
|
|
The costo-phrenic angle is seen clearly on fluoroscopy at the end of the procedure. This determines absence of pleural violation.
|
| Stone burden | Supra-12th puncture, n | Supra-11th puncture, n | Supra-10th puncture, n | Total, n (%) | | Upper calyceal stone | 43 | 13 | 7 | 63 (18.2) | | Staghorn stone | 133 | 34 | 4 | 171 (49.3) | | Impacted large upper ureteric stone | 40 | 22 | 0 | 62 (17.9) | | Upper ureteric stone with lower calyceal stone | 26 | 13 | 0 | 39 (11.2) | | Upper calyx diverticular stone | 6 | 3 | 3 | 12 (3.5) | | Total | 248 | 85 | 14 | 347 |
|
|
Distribution of patients according to stone burden and the site of puncture.
|
| Variable | All supracostal punctures (n=347) | Supra-12th punctures (n=248) | Supra-11th punctures (n=85) | Supra-10th punctures (n=14) | p-Value | | Hydrothorax, n (%) | 17 (4.9) | 3 (1.2) | 9 (10.6) | 5 (35.7) | <0.001 (supra-11th vs. supra-12th); 0.026 (supra-10th vs. supra-11th) | | Intercostal drain, n (%) | 7 (2.0) | 0 | 2 (2.4) | 5 (35.7) | 0.06 (supra-11th vs. supra-12th); <0.001 (supra- 10th vs. supra-11th) |
|
|
Incidence of hydrothorax and intercostal drain requirement in supracostal percutaneous nephrolithotomy.
|
| Variable | Univariable analysis | Multivariable analysis | | OR (95% CI) | p-Value | OR (95% CI) | p-Value | | Age (≤18 vs. >18), year | 1.112 (1.032-1.203) | 0.02 | 1.082 (0.899-1.215) | 0.3 | | Renal anatomy (anteriorly malrotated vs. normal) | 2.803 (1.131-5.364) | 0.026 | 2.722 (1.042-5.617) | 0.03 | | Puncture in relation to mid-scapular line (medial vs. lateral) | 1.733 (1.071-2.738) | 0.03 | 1.669 (0.542-1.578) | 0.03 | | Level of supracostal puncture (Supra-10th or 11th vs. supra-12th) | 4.677 (1.763-7.771) | <0.001 | 5.265 (1.292-9.342) | <0.001 | | Number of tracts (supra + subcostal vs. only supracostal) | 1.250 (0.467-1.044) | 0.1 | - | - |
|
|
Univariable and multivariable logistic regression analysis to determine predictors of hydrothorax following supracostal percutaneous nephrolithotomy.
|
| [1] |
Turk C, Neisius A, Petrik C, Seitz A, Skolarikos B, Thomas K. EAU urolithiasis guidelines. https://uroweb.org/guideline/urolithiasis/. [Accessed 5 March 2020].
|
| [2] |
Munver R, Delvecchio FC, Newman GE, Preminger GM. Critical analysis of supracostal access for percutaneous renal surgery. J Urol 2001; 166:1242e6.
pmid: 11547050
|
| [3] |
Kekre NS, GopalakrishnanGG, GuptaGG, AbrahamBN, Sharma E. Supracostal approach in percutaneous nephrolithotomy: experience with 102 cases. J Endourol 2001; 15:789e91.
pmid: 11724115
|
| [4] |
Yadav R, Aron M, Gupta NP, Hemal AK, Seth A, Kolla SB. Safety of supracostal punctures for percutaneous renal surgery. Int J Urol 2006; 13:1267e70.
doi: 10.1111/j.1442-2042.2006.01537.x
|
| [5] |
Mousavi-Bahar SH, Mehrabi S, Moslemi MK. The safety and efficacy of PCNL with supracostal approach in the treatment of renal stones. Int Urol Nephrol 2011; 43:983e7.
doi: 10.1007/s11255-011-9916-y
pmid: 21394440
|
| [6] |
Sukumar S, Nair B, Kumar PG, Sanjeevan KV, Bhat HS. Supracostal access for percutaneous nephrolithotomy: less morbid, more effective. Int Urol Nephrol 2008; 40:263e7.
pmid: 17899435
|
| [7] |
Ozgor F, Tepeler A, Basibuyuk I, Kucuktopcu O, Kayali Y, Yanaral F, et al. Supracostal access for miniaturized percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. Urolithiasis 2018; 46:279e83.
doi: 10.1007/s00240-017-0976-z
|
| [8] |
Mahmood Ahmed M, Ahmad Najar F. Safety and efficacy of supracostal superior calyceal approach for percutaneous renal surgery. Turk J Urol 2018; 45(Supp. 1):S121e4. https://doi.org/10.5152/tud.2018.47529.
|
| [9] |
Shaban A, Kodera A, El Ghoneimy MN, Orban TZ, Mursi K, Hegazy A. Safety and efficacy of supracostal access in percutaneous renal surgery. J Endourol 2008; 22:29e33.
pmid: 18095859
|
| [10] |
Sinha M, Krishnappa P, Subudhi SK, Krishnamoorthy V. Supracostal percutaneous nephrolithotomy: a prospective comparative study. Indian J Urol 2016; 32:45e9.
doi: 10.4103/0970-1591.173121
|
| [11] |
He Z, Tang F, Lu Z, He Y, Wei G, Zhong F, et al. Comparison of supracostal and infracostal access for percutaneous nephrolithotomy: a systematic reviewandmeta-analysis. Urol J 2019; 16:107e14.
|
| [12] |
Kara C, De_girmenci T, Kozacioglu Z, Gunlusoy B, Koras O, Minareci S. Supracostal approach for PCNL: is 10th and 11th intercostal space safe according to Clavien classification system? Int Surg 2014; 99:857e62.
doi: 10.9738/INTSURG-D-13-00167.1
|
| [13] |
Maheshwari PN, Mane DA, Pathak AB. Management of pleural injury after percutaneous renal surgery. J Endourol 2009; 23:1769e72.
doi: 10.1089/end.2009.1549
pmid: 19785558
|
| [14] |
de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 2011; 25:11e7.
doi: 10.1089/end.2010.0424
pmid: 21247286
|
| [15] |
Maheshwari PN, Chopade DK, Andankar MG. Comment on "Supracostal approach in percutaneous nephrolithotomy: experience of 102 cases". J Endourol 2003; 17:529e30.
pmid: 14565888
|
| [16] |
Stening SG, Bourne S. Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi. J Endourol 1998; 12:359e62.
pmid: 9726403
|
| [17] |
Goldberg H, Nevo A, Shtabholtz Y, Lubin M, Baniel J, Margel D, et al. Tubeless supra-costal percutaneous nephrolithotomy is associated with significantly less hydrothorax: a prospective randomized clinical study. BJU Int 2020; 125:276e83.
doi: 10.1111/bju.14950
pmid: 31721407
|
| [1] |
Erhan Demirelli,Ercan Öğreden,Cemil Bayraktar,Alptekin Tosun,Ural Oğuz. The effect of perirenal fat stranding on infectious complications after ureterorenoscopy in patients with ureteral calculi[J]. Asian Journal of Urology, 2022, 9(3): 307-312. |
| [2] |
Sujeet Poudyal. Current insights on haemorrhagic complications in percutaneous nephrolithotomy[J]. Asian Journal of Urology, 2022, 9(1): 81-93. |
| [3] |
Abhishek Gajendra Singh,Sundaram Palaniappan,Shrikant Jai,Gopal Tak,Arvind Ganpule,Ravindra Sabnis,Mahesh Desai. The clinical outcomes of laser with suction device in mini-percutaneous nephrolithotomy[J]. Asian Journal of Urology, 2022, 9(1): 63-68. |
| [4] |
Dilip K. Mishra,Sonia Bhatt,Sundaram Palaniappan,Talamanchi V.K. Reddy,Vinothkumar Rajenthiran,Y.L. Sreeranga,Madhu S. Agrawal. Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population[J]. Asian Journal of Urology, 2022, 9(1): 75-80. |
| [5] |
Yiwei Wang, Liheng Gao, Mingxi Xu, Wenfeng Li, Yuanshen Mao, Fujun Wang, Lu Wang, Jun Da, Zhong Wang. A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study[J]. Asian Journal of Urology, 2021, 8(4): 424-429. |
| [6] |
Braulio Omar Manzo,Jose David Cabrera,Esteban Emiliani,Hector Manuel Sánchez,Brian Howard Eisner,Jose Ernesto Torres. Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones[J]. Asian Journal of Urology, 2021, 8(3): 275-279. |
| [7] |
Sarwar Noori Mahmood,Hewa Toffeq,Saman Fakhralddin. Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers[J]. Asian Journal of Urology, 2020, 7(3): 309-317. |
| [8] |
Sudharsan Balaji,Arvind Ganpule,Thomas Herrmann,Ravindra Sabnis,Mahesh Desai. Contemporary role of multi-tract percutaneous nephrolithotomy in the treatment of complex renal calculi[J]. Asian Journal of Urology, 2020, 7(2): 102-109. |
| [9] |
Etienne Xavier Kellera,Vincent De Conincka,Steeve Doizia,Olivier Traxer. The role of ureteroscopy for treatment of staghorn calculi: A systematic review[J]. Asian Journal of Urology, 2020, 7(2): 110-115. |
| [10] |
Osman Ermis,Bhaskar Somani,Thomas Reeves,Selcuk Guven,Pilar Laguna Pes,Arun Chawla,Padmaraj Hegde,Jean de la Rosette. Definition, treatment and outcome of residual fragments in staghorn stones[J]. Asian Journal of Urology, 2020, 7(2): 116-121. |
| [11] |
Xiaofeng Gao,Ziyu Fang,Chaoyue Lu,Rong Shen,Hao Dong,Yinghao Sun. Management of staghorn stones in special situations[J]. Asian Journal of Urology, 2020, 7(2): 130-138. |
| [12] |
Nariman Gadzhiev,Vigen Malkhasyan,Gagik Akopyan,Sergei Petrov,Francis Jefferson,Zhamshid Okhunov. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications[J]. Asian Journal of Urology, 2020, 7(2): 139-148. |
| [13] |
Jared S. Winoker,Ryan A. Chandhoke,William Atallah,Mantu Gupta. Morphometry scores: Clinical implications in the management of staghorn calculi[J]. Asian Journal of Urology, 2020, 7(2): 78-86. |
| [14] |
lIlan Klein,Jorge Gutiérrez-Aceves. Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi[J]. Asian Journal of Urology, 2020, 7(2): 87-93. |
| [15] |
Arvind P. Ganpule,M. Naveen Kumar Reddy,S.B. Sudharsan,Shaishav B. Shah,Ravindra B. Sabnis,Mahesh R. Desai. Multitract percutaneous nephrolithotomy in staghorn calculus[J]. Asian Journal of Urology, 2020, 7(2): 94-101. |
|
|
|
|
