title: Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access. A retrospective study.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, Sweden. eva.radecka@rtg.uas.lul.se
authors.forename: E
authors.initials: E
authors.lastname: Radecka
authors.forename: M
authors.initials: M
authors.lastname: Brehmer
authors.forename: K
authors.initials: K
authors.lastname: Holmgren
authors.forename: A
authors.initials: A
authors.lastname: Magnusson
mesh_terms: D005471:Fluoroscopy; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects* / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D010996:Pleural Effusion / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D011677:Punctures; D012189:Retrospective Studies; D012272:Ribs; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography