Document Detail

Is the 10th and 11th intercostal space a safe approach for percutaneous nephrostomy and nephrolithotomy?
MedLine Citation:
PMID:  15383855     Owner:  NLM     Status:  MEDLINE    
The aim of this study was to determine the rate of complications in percutaneous nephrostomy (PCN) and nephrolithotomy (PCNL) performed through the 11th and 10th intercostal spaces using our monitoring technique and to discuss the safety of the procedure. Out of 398 PCNs and PCNLs carried out during a 3-year period, 56 patients had 57 such procedures performed using an intercostal approach. The 11th intercostal route was used in 42 and the 10th in 15 cases. One patient had two separate nephrostomies performed through the 10th and 11th intercostal spaces. The technique utilizes bi-planar fluoroscopy with a combination of a conventional angiographic machine to provide anterior-posterior fluoroscopy and a C-arm mobile fluoroscopy machine to give a lateral view, displayed on two separate monitors. None of the patients had clinically significant thoracic or abdominal complications. Two patients had minor chest complications. Only one developed changes (plate atelectasis, elevation of the hemi-diaphragm) directly related to the nephrostomy (2%). The second patient had bilateral plate atelectasis and unilateral congestive lung changes after PCNL. These changes were not necessarily related to the procedure but rather to general anesthesia during nephrolithotomy. The authors consider PCN or PCNL through the intercostal approach a safe procedure with a negligible complication rate, provided that it is performed under bi-planar fluoroscopy, which allows determination of the skin entry point just below the level of pleural reflection and provides three-dimensional monitoring of advancement of the puncturing needle toward the target entry point.
Ahmed Al Muzrakchi; W Szmigielski; Ahmed J S Omar; Nagy M Younes
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Publication Detail:
Type:  Journal Article     Date:  2004-08-12
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  27     ISSN:  0174-1551     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:    2004 Sep-Oct
Date Detail:
Created Date:  2004-09-22     Completed Date:  2006-08-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  503-6     Citation Subset:  IM    
Department of Radiology, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
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MeSH Terms
Kidney Calculi / surgery
Middle Aged
Nephrostomy, Percutaneous / adverse effects,  methods*
Treatment Outcome
Ureteral Obstruction / surgery
Urinary Bladder Neoplasms / surgery

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