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Management of nephropleural fistula after supracostal percutaneous nephrolithotomy.

Publication ,  Journal Article
Lallas, CD; Delvecchio, FC; Evans, BR; Silverstein, AD; Preminger, GM; Auge, BK
Published in: Urology
August 2004

OBJECTIVES: Access to complex urinary tract pathology may require supracostal access placing patients at risk for intrathoracic complications. Our objective was to retrospectively review our experience with percutaneous renal surgery with a particular emphasis on identifying the incidence of nephropleural fistula and management of this unusual complication. METHODS: The records of 375 consecutive patients who underwent percutaneous renal surgery between 1993 and 2001 were reviewed. Supracostal access was placed to address the intrarenal pathologic findings most directly in 120 (26.0%) of the 462 tracts, with 87 (18.8%) above the 12th rib, 32 (6.9%) above the 11th rib, and 1 (0.2%) above the 10th rib. RESULTS: Of 375 patients, 4 (1%) developed a nephropleural fistula. Of the 87 with supracostal-12th rib access, 2 (2.3%) developed a nephropleural fistula, and 2 (6.3%) of the 32 with supracostal-11th rib access developed the same complication. The overall incidence of nephropleural fistulas in our patient population per access tract placed was 0.87% (4 of 462 percutaneous tracts), which increased to 3.3% (4 of 120) when considering only supracostal access. All patients were treated conservatively, although 1 patient required thoracoscopy with decortication for persistent pleural effusion. No further sequelae developed in any of the other 3 patients, and all fistulas had resolved at 3 months of follow-up. CONCLUSIONS: As aggressive percutaneous renal surgery with supracostal access to the collecting system becomes more common, the incidence of intrathoracic complications, including nephropleural fistula, may increase. Early recognition and management of a pleural injury is critical to avoid life-threatening situations. Low-morbidity measures are typically successful; however, more aggressive treatment may be required on occasion.

Duke Scholars

Published In

Urology

DOI

EISSN

1527-9995

Publication Date

August 2004

Volume

64

Issue

2

Start / End Page

241 / 245

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Fistula
  • Thoracoscopy
  • Suction
  • Stents
  • Retrospective Studies
  • Respiratory Tract Fistula
  • Postoperative Complications
  • Pleural Effusion
  • Nephrostomy, Percutaneous
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lallas, C. D., Delvecchio, F. C., Evans, B. R., Silverstein, A. D., Preminger, G. M., & Auge, B. K. (2004). Management of nephropleural fistula after supracostal percutaneous nephrolithotomy. Urology, 64(2), 241–245. https://doi.org/10.1016/j.urology.2004.03.031
Lallas, Costas D., Fernando C. Delvecchio, Brian R. Evans, Ari D. Silverstein, Glenn M. Preminger, and Brian K. Auge. “Management of nephropleural fistula after supracostal percutaneous nephrolithotomy.Urology 64, no. 2 (August 2004): 241–45. https://doi.org/10.1016/j.urology.2004.03.031.
Lallas CD, Delvecchio FC, Evans BR, Silverstein AD, Preminger GM, Auge BK. Management of nephropleural fistula after supracostal percutaneous nephrolithotomy. Urology. 2004 Aug;64(2):241–5.
Lallas, Costas D., et al. “Management of nephropleural fistula after supracostal percutaneous nephrolithotomy.Urology, vol. 64, no. 2, Aug. 2004, pp. 241–45. Pubmed, doi:10.1016/j.urology.2004.03.031.
Lallas CD, Delvecchio FC, Evans BR, Silverstein AD, Preminger GM, Auge BK. Management of nephropleural fistula after supracostal percutaneous nephrolithotomy. Urology. 2004 Aug;64(2):241–245.
Journal cover image

Published In

Urology

DOI

EISSN

1527-9995

Publication Date

August 2004

Volume

64

Issue

2

Start / End Page

241 / 245

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Fistula
  • Thoracoscopy
  • Suction
  • Stents
  • Retrospective Studies
  • Respiratory Tract Fistula
  • Postoperative Complications
  • Pleural Effusion
  • Nephrostomy, Percutaneous