ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Percutaneous nephrolithotomy: a cause of specific and iatrogenic thoracic complications
Rasih Yazkan1, Taylan Oksay2, Alper Özorak2, İsa Döngel1, Sefa Alperen Öztürk2, Alim Koşar2
1Department of Thoracic Surgery, Medical Faculty of Süleyman Demirel University, Isparta, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.7928
Background: This study aims to evaluate thoracic complications which are usually encountered in percutaneous nephrolithotomy.

Methods: Between February 2005 and September 2012, 932 patients (586 males, 346 females; mean age 44.98±16.35 years; range 2 to 85 years) underwent percutaneous nephrolithotomy due to the nephrolithiasis. All patients were evaluated with preoperative posteroanterior chest X-ray while all patients who had supracostal access and who had suspected thoracic complications were evaluated with postoperative posteroanterior chest X-rays. Tube thoracostomy was performed in all patients with thoracic complications.

Results: A subcostal access was performed in 849 patients (91%), whereas a supracostal access was performed in 83 patients (9%). Thoracic complications were developed in 18 patients (1.93%). Of them, 13 (1.39%) were in patients with supracostal and five (0.54%) were in patients with subcostal approach. Eleven supracostal accesses were performed above the 12th rib and two supracostal accesses were above the 11th rib. When all complications were evaluated, 12 hemothoraces, four pneumothoraces, and two urinothoraces were detected.

Conclusion: Percutaneous nephrolithotomy is a cause of iatrogenic thoracic complications and supracostal approach has a more thoracic complication rate, compared to the subcostal approach. An early postoperative posteroanterior chest X-ray in sitting or standing position following supracostal access in particular is an essential diagnostic tool for early detection of thoracic complications. The tube thoracostomy is usually sufficient for the treatment of such complications.

Keywords : Complication; iatrogenic; percutaneous nephrolithotomy; thoracic
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