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A percutaneous subcostal approach for intercostal stones
Jameel Rehman1, Bilal Chughtai, David Schulsinger
1Department of Urology, Albany Medical Center, Albany, New York, USA. jrehman@notes.cc.sunysb.edu
Journal of Endourology
|February 27, 2008
Summary
A novel subcostal percutaneous approach safely accesses upper pole kidney stones above the 12th rib, reducing intrathoracic complication risks. This technique is suitable for select patients when other methods fail.
Area of Science:
- Nephrology
- Urology
- Minimally Invasive Surgery
Background:
- Percutaneous nephrostomy for upper pole renal stones carries a risk of intrathoracic complications, particularly with cranial tract placement.
- Traditional supracostal or subcostal approaches may be limited by stone location above the 12th rib.
Observation:
- A case involving a 78-year-old male with a large (3 x 2.2 cm) upper pole right renal stone, situated between the 11th and 12th ribs, extending above the 10th rib.
- Ureteroscopic and shockwave lithotripsy were deemed infeasible due to stone size and location.
Findings:
- A modified subcostal percutaneous access technique was employed, angling the tract laterally and cranially to pass below the 12th rib while entering the upper pole calix.
- Successful fragmentation and complete stone removal were achieved using ultrasonic lithotripsy and suction, with no postoperative intrathoracic or pulmonary complications.
Implications:
- This subcostal angled percutaneous approach offers a safe alternative for managing upper pole renal calculi located above the 12th rib when less invasive methods are not viable.
- Careful anatomical consideration and precise technique can mitigate the risk of intrathoracic complications associated with percutaneous upper pole access.
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