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Evaluation of factors predicting clinical pleural injury during percutaneous nephrolithotomy: a prospective study

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Abstract

The purpose of this study is to prospectively identify factors that predict the chance of pleural injury (detected clinically or on postoperative X-ray chest) during percutaneous nephrolithotomy (PCNL). All patients with renal/upper ureteric stones, undergoing PCNL between January 2013 and June 2014, were evaluated for pleural injury. An erect chest X-ray on inspiration was done within 6 h of PCNL. The patients were divided into Groups A and B depending on whether they developed or did not develop pleural injury. Patient-, stone-, renal-, and procedure-related factors were compared between the two groups. 332 patients with mean age 36.76 ± 15.01 years (range 4–80) and M:F of 172:160 fulfilled the inclusion criteria. Pleural complications occurred in 10 patients (3 %). Of 141 patients with supracostal punctures (59 had additional infracostal punctures), 4.2 % (n = 6) had pleural injury. Of 191 patients with only infracostal punctures, 4 developed pleural injuries (2 %). Patients in group A had significantly lower age (27.00 ± 11.18 vs. 37.06 ± 15.03, p = 0.03) and lower BMI (18.0 ± 1.90 vs. 21.12 ± 2.24 p = 0.002). Incidence of pleural injury was significantly higher (p = 0.001) on right side [4.0 % (7/172) vs. 1.8 %, 3/160)]. Incidence of pleural injury had no association with staghorn calculi, stone surface area (590.51 ± 313.88 for Group A vs. 593.02 ± 387.10 for Group B; p = 0.11), degree of hydronephrosis, and operative time (65.13 ± 19.45 for Group A vs. 72.21 ± 19.56 for Group B; p = 0.06). On multivariate analysis, only low BMI and mean age <27 years were associated with higher risk of pleural injury. Higher incidence of pleural injury was noted in patients with low BMI and younger age.

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References

  1. Skolarikos A, de la Rosette JJ (2008) Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol 18:229–234

    Article  PubMed  Google Scholar 

  2. Skolarikos A, Alivizatos G, De La Rosette JJMCH (2005) Percutaneous nephrolithotomy and its legacy. Eur Urol 47:22–28

    Article  CAS  PubMed  Google Scholar 

  3. Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, Grabe M, Rosette (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25:1275–1280

    Article  PubMed  Google Scholar 

  4. Labadie K, Okhunov Z, Akhavein A, Moreira DM, Moreno-Palacios J, Del Junco M, Okeke Z, Bird V, Smith AD, Landman J (2015) Evaluation and comparison of urolithiasis scoring systems used in percutaneous kidney stone surgery. J Urol 193(1):154–159

    Article  PubMed  Google Scholar 

  5. Picus D, Weyman PJ, Clayman RV, McClennan BL (1986) Intercostal-space nephrostomy for percutaneous stone removal. Am J Roentgenol 147:393–397

    Article  CAS  Google Scholar 

  6. Munver R, Delvecchio FC, Newman GE, Preminger GM (2001) Critical analysis of supracostal access for percutaneous renal surgery. J Urol 166:1242–1246

    Article  CAS  PubMed  Google Scholar 

  7. Lojanapiwat B, Prasopsuk S (2006) Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol 20:491–494

    Article  CAS  PubMed  Google Scholar 

  8. Hopper KD, Yakes WF (1990) The posterior intercostal approach for percutaneous renal procedures: risk of puncturing the lung, spleen, and liver as determined by CT. Am J Roentgenol 154:115–117

    Article  CAS  Google Scholar 

  9. Noble VE, Brown DFM (2004) Renal ultrasound. Emerg Med Clin N Am 22:641–659

    Article  Google Scholar 

  10. MacDuff A, Arnold A, Har J, BTS Pleural disease Guideline Group (2010) Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 65:18–31

    Article  Google Scholar 

  11. Ogan K, Corwin TS, Smith T, Watumull LM, Mullican MA, Cadeddu JA, Pearle MS (2003) Sensitivity of chest fluoroscopy compared with chest CT and chest radiography for diagnosing hydropneumothorax in association with percutaneous nephrostolithotomy. Urology 62:988–992

    Article  PubMed  Google Scholar 

  12. Bjurlin MA, O’Grady T, Kim R, Jordan MD, Goble SM, Hollowell CM (2012) Is routine postoperative chest radiography needed after percutaneous nephrolithotomy? Urology 79(4):791–795

    Article  PubMed  Google Scholar 

  13. de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, CROES PCNL Study Group et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol. 25:11–17

    Article  PubMed  Google Scholar 

  14. Dawson B, Trapp RG (2004) Basic & clinical biostatistics. International edition, 4th edn. Mc-Graw-Hill, New York, pp 126–127

    Google Scholar 

  15. Sofer M, Druckman I, Blachar A, Ben-Chaim J, Matzkin H, Aviram G (2012) Noncontrast computed tomography after percutaneous nephrolithotomy: findings and clinical significance. Urology 79(5):1004–1010

    Article  PubMed  Google Scholar 

  16. Goyal NK, Goel A (2012) Re: Sofer M et al.: Mandal Noncontrast computed tomography after percutaneous nephrolithotomy: findings and clinical significance. Urology 80(3):740. doi:10.1016/j.urology.2012.03.041

    Article  PubMed  Google Scholar 

  17. Arafa AS, Al Kandari AM (2013) Visceral complications of percutaneous nephrolithotomy (PCNL). Difficult cases in endourology, 1st edn. Springer, Newyork, pp 63–72

    Book  Google Scholar 

  18. Agasti TK (2011) Anatomy and physiology of respiratory system. Textbook of anaesthesia for postgraduates, 1st edn. Jaypee, New Delhi, pp 17–33

  19. Johnson D, Shah P, Collins P, Wigley C (2008) Gray’s anatomy—the anatomical basis of clinical practice. 39 edn. Elsevier Churchill Livingstone, Philadelphia, pp 1063–1067

  20. Bruhn A, Hyams E, Shah O (2010) Percutaneous nephrolithotomy in obese patients: could obesity be protective for access? J Urol 183:e610

    Article  Google Scholar 

  21. Palnizky G, Halachmi S, Barak M (2013) Pulmonary complications following percutaneous nephrolithotomy: a prospective study. Curr Urol 7:113–116

    Article  PubMed  Google Scholar 

  22. Okeke Z, Smith AD, Labate G, D’Addessi A, Venkatesh R, Assimos D, Strijbos WE, de la Rosette JJ, CROES PCNL Study Group (2012) Prospective comparison of outcomes of percutaneous nephrolithotomy in elderly patients versus younger patients. J Endourol. 26:996–1001

    Article  PubMed  Google Scholar 

  23. Kumar R, Saxena V, Anand A, Seth A, Dogra PN, Gupta NP (2011) Chest complications following supracostal PCNL may be delayed and are more common on the right side. Urology 78:S105

    Article  Google Scholar 

  24. Maheshwari PN, Andankar MG, Hegde S, Bansal M (2000) The supracostal approach for percutaneous nephrolithotomy. BJU Int 85:557–559

    Google Scholar 

  25. Knoll T, Michel MS, Alken P (2007) Surgical Atlas. Percutaneous nephrolithotomy: the Mannheim technique. BJU Int 99:213–231

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge the work done by Mr. Naushad Hussain and Mr. Rakesh for their help in record keeping, and Mr. R. K Mishra for his help in statistical evaluation.

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Authors and Affiliations

  1. Department of Urology, King George Medical University, Lucknow, UP, India

    Kuldeep Sharma, Satya Narayan Sankhwar, Vishwajeet Singh, Bhupendra Pal Singh, Diwakar Dalela, Rahul Janak Sinha, Manoj Kumar, Manmeet Singh & Apul Goel

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  1. Kuldeep Sharma
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  2. Satya Narayan Sankhwar
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  3. Vishwajeet Singh
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  4. Bhupendra Pal Singh
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  5. Diwakar Dalela
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  6. Rahul Janak Sinha
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  7. Manoj Kumar
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  8. Manmeet Singh
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  9. Apul Goel
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Correspondence to Apul Goel.

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All authors declare, that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sharma, K., Sankhwar, S.N., Singh, V. et al. Evaluation of factors predicting clinical pleural injury during percutaneous nephrolithotomy: a prospective study. Urolithiasis 44, 263–270 (2016). https://doi.org/10.1007/s00240-015-0820-2

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  • DOI: https://doi.org/10.1007/s00240-015-0820-2

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