Flashcard: A 57-year-old woman with pleural effusion following percutaneous nephrolithotripsy

Urinothorax: a systematic review

“…The pH in UT is usually acidic (60% had pH ≤7.30) which is explained by the presence of clearly acidotic urine. However, in 24% (6/25) of the cases reviewed, pH level was ≥7.50 (21,48,56,66,78). It has been speculated that urinoma with hematuric urine, in addition to raising PF protein levels, could have the same effect on the pH (50), but in this review none of the 6 cases with pH ≥7.50 had hematic PF.…”

“…The color of the PE was documented in 33 cases (37.5%): it was straw-colored in 24 (72.7%) and hematic in 9 cases (27.3%). PF odor was only mentioned in 8 case reports (9.1%), described as urinelike or ammoniacal in all cases (5,15,58,63,66,68,75,78). Biochemical characteristics and cellular differentiation of PF were described in only a few cases ( Table 3).…”

“…No direct treatment was applied in 4 patients; 2 with renal stone disease resolved spontaneously (28,39) and the other 2 died (38,48). Finally, the treatment applied in 10 patients was not documented (2,8,10,15,45,52,59,61,63,78).…”

“…Biochemical characteristics and cellular differentiation of PF were described in only a few cases ( Table 3). The question of whether the PE was transudate or exudate was mentioned in 32 reports: 18 were transudate and 14 (43.8%) exudate [3 concordant (59,63,66), 1 protein-discordant (50) and 10 LDH-discordant (15,31,39,57,61,68,72,73,78), according to the classification system of Agrawal et al (82)]. PF/S creatinine ratio was determined in 48 cases (54.5%) and only one (2%) was <1 (0.95) (63).…”

Comparison of Clinical Effects of Percutaneous Nephrolithotomy and Ureteroscopic Holmium Laser Lithotripsy for Renal Calculi

“…Surgical position, the traditional PCNL position is prone position surgery, patients need to after anesthesia by supine pose for the prone position, this position kidney position relatively fixed, the more clearly on the anatomy, there are many defects, but also need to put the position after anesthesia and secondary sterilization draping, patients with prone position is more likely to cause discomfort, a series of changes is lowered, the body's blood dynamics change; The oblique supine lithotomy position can alleviate this problem and significantly increase the surgical tolerance of patients. Moreover, for complex upper urinary calculi, the oblique supine lithotomy position can reserve the treatment space for dual mirror combination, thus improving the treatment effect of complex urinary calculi [4].…”