Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy

Objective: To report our experience with supracostal percutaneous nephrolithotomy (SC-PNL) and evaluate factors which could predict the risk of hydrothorax following SC-PNL. Methods: We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019. Patients were assessed for demograp...

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Main Authors: Pankaj N. Maheshwari, Amandeep Arora, Mahesh S. Sane, Vivek Jadhao
Format: Article
Language:English
Published: Elsevier 2022-07-01
Series:Asian Journal of Urology
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2214388222000108
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author Pankaj N. Maheshwari
Amandeep Arora
Mahesh S. Sane
Vivek Jadhao
author_facet Pankaj N. Maheshwari
Amandeep Arora
Mahesh S. Sane
Vivek Jadhao
author_sort Pankaj N. Maheshwari
collection DOAJ
description Objective: To report our experience with supracostal percutaneous nephrolithotomy (SC-PNL) and evaluate factors which could predict the risk of hydrothorax following SC-PNL. Methods: We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019. Patients were assessed for demographic characteristics, indication for the supracostal access, level of supracostal access, anatomy of the kidney (normal or malrotated), site of the puncture in relation to the mid-scapular line (medial or lateral), and whether another subcostal tract for stone clearance was required or not. Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access. In addition, a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL. Results: Of the 347 patients with SC-PNL, 248 (71.5%) underwent a supra-12th rib approach, while the rest needed a supra-11th (n=85; 24.5%) or a supra-10th (n=14; 4.0%) rib tract. Overall, 17 (4.9%) patients developed a hydrothorax, while an intercostal-drain was required in seven of these 17 patients for 48 h. None of the patients with a supra-12th rib puncture required an intercostal-drain. More than a third of the patients with a supra-10th puncture developed a hydrothorax (35.7%) and all of them required an intercostal drain. Factors such as anteriorly malrotated kidney (odds ratio [OR]=2.722; 95% confidence interval [CI]=1.042–5.617, p=0.03), puncture medial to the mid-scapular line (OR=1.669; CI=0.542–1.578, p=0.03), and an access higher than the supra-12th level (OR=5.265; CI=1.292–9.342, p<0.001) proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis. Conclusion: Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low. Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.
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spelling doaj.art-0024acacd0b84fc2865d068511b6769e2022-12-22T02:51:17ZengElsevierAsian Journal of Urology2214-38822022-07-0193301306Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomyPankaj N. Maheshwari0Amandeep Arora1Mahesh S. Sane2Vivek Jadhao3Corresponding author.; Department of Urology, Fortis Hospital Mulund, Mumbai, IndiaDepartment of Urology, Fortis Hospital Mulund, Mumbai, IndiaDepartment of Urology, Fortis Hospital Mulund, Mumbai, IndiaDepartment of Urology, Fortis Hospital Mulund, Mumbai, IndiaObjective: To report our experience with supracostal percutaneous nephrolithotomy (SC-PNL) and evaluate factors which could predict the risk of hydrothorax following SC-PNL. Methods: We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019. Patients were assessed for demographic characteristics, indication for the supracostal access, level of supracostal access, anatomy of the kidney (normal or malrotated), site of the puncture in relation to the mid-scapular line (medial or lateral), and whether another subcostal tract for stone clearance was required or not. Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access. In addition, a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL. Results: Of the 347 patients with SC-PNL, 248 (71.5%) underwent a supra-12th rib approach, while the rest needed a supra-11th (n=85; 24.5%) or a supra-10th (n=14; 4.0%) rib tract. Overall, 17 (4.9%) patients developed a hydrothorax, while an intercostal-drain was required in seven of these 17 patients for 48 h. None of the patients with a supra-12th rib puncture required an intercostal-drain. More than a third of the patients with a supra-10th puncture developed a hydrothorax (35.7%) and all of them required an intercostal drain. Factors such as anteriorly malrotated kidney (odds ratio [OR]=2.722; 95% confidence interval [CI]=1.042–5.617, p=0.03), puncture medial to the mid-scapular line (OR=1.669; CI=0.542–1.578, p=0.03), and an access higher than the supra-12th level (OR=5.265; CI=1.292–9.342, p<0.001) proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis. Conclusion: Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low. Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.http://www.sciencedirect.com/science/article/pii/S2214388222000108Calculous diseaseStoneSupracostalPercutaneous nephrolithotomyHydrothorax
spellingShingle Pankaj N. Maheshwari
Amandeep Arora
Mahesh S. Sane
Vivek Jadhao
Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
Asian Journal of Urology
Calculous disease
Stone
Supracostal
Percutaneous nephrolithotomy
Hydrothorax
title Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
title_full Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
title_fullStr Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
title_full_unstemmed Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
title_short Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
title_sort evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy
topic Calculous disease
Stone
Supracostal
Percutaneous nephrolithotomy
Hydrothorax
url http://www.sciencedirect.com/science/article/pii/S2214388222000108
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