An insight into predominance of pulmonary complications on right side in supracostal percutaneous nephrolithotomy

Abstract

Purpose: To analyse pulmonary complications following supracostal percutaneous nephrolithotomy especially after right sided supracostal punctures, both in initial and relook PCNL. Material and methods: From February 2016 till date, 90 patients underwent PCNL in Government Medical College, Jammu through supracostal puncture – 53 on right side and 37 on left side. All supracostal punctures were made about 7–8.5 cm from midline. Tract dilatation was done using metal dilators and calculi were fragmented using pneumatic lithotripsy. Patients with supracostal superior calyceal punctures were evaluated for chest complications intraoperatively by fluoroscopy, X-ray chest on evening of postoperative day 0 and repeated thereafter on third and seventh postoperative days. Results: Stone configuration included complete staghorn in 16, partial staghorn in 23, multiple stones in 16 and pelvic stone in 35 cases. Age range of patients was 07–76 years. There was 14.4% (13 out of 90) incidence of early or delayed chest complications – 20.8% (11 out of 53) on right side and 5.4% (2 out of 37) on left side. Conclusion: Pulmonary complications in supracostal punctures; especially on right side should not be underestimated. There are always chances of delayed hydrothorax after supracostal puncture. A chest X-ray should be repeated after 1 week in patients with supracostal PCNL punctures.

Acute liver injury and contralateral pleural effusion as two rare complications following percutaneous nephrolithotomy: a case report

“…Additionally, intraoperative blood transfusion is a risk factor for postoperative pulmonary complications. Ample irrigation fluids during PCNL can contribute to congestion and pulmonary edema [10,11,17,18]. Based on the literature, pulmonary complications after PCNL are a recognized adverse event.…”

“…Surgery near the diaphragm and close to the pleura, as well as supracostal access and anesthesia, are risk factors for causing pulmonary complications. In the PCNL technique, there is a risk of puncturing the pleura and lung, leading to pulmonary complications such as pneumothorax, hemothorax, pleural effusion, pneumonia, and atelectasis [10,11].…”