Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy.
OBJECTIVE
The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy.


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.


CONCLUSIONS
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.
Lang
Erich K
EK
Department of Radiology, SUNY Downstate School of Medicine, Brooklyn, New York 11231, USA. erich.lang@downstate.edu
Thomas
Raju
R
Davis
Rodney
R
Colon
Ivan
I
Cheung
Wellman
W
Sethi
Erum
E
Rudman
Ernest
E
Hanano
Amer
A
Myers
Leann
L
Kagen
Alexander
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult