JOURNAL ARTICLE
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Small-bore catheter drainage of pleural injury after percutaneous nephrolithotomy: feasibility and outcome from a single large institution series.

BACKGROUND AND PURPOSE: A well-known complication of percutaneous nephrolithotomy (PCNL) is pleural injury. Pneumothorax and hydrothorax sustained during PCNL may necessitate the placement of a chest tube. Current literature describes placement of standard chest tubes as well as small-bore catheters for management of hydrothorax sustained during PCNL. This study aims to better delineate the clinical utility and outcomes associated with use of small-bore catheters when compared with standard chest tubes for managing pneumothorax and hydrothorax after PCNL.

PATIENTS AND METHODS: We queried an institutional database of 735 renal units that underwent PCNL for endourologic disease between 2001 and 2013. Postoperative upright chest radiographs were analyzed in patients who needed chest tube placement for pneumothorax or hydrothorax after PCNL. Those who met inclusion criteria were divided based on the size of chest tube placed: Small-bore (8-12F) or standard chest tube (32F). Analysis of clinical outcomes was performed.

RESULTS: Of the 735 procedures, 15 (2% of total, 7 right, 8 left) needed chest tube placement for a pleural injury after PCNL. Those who needed chest tube placement had an average stone size of 2.1 cm. Five had large-bore standard chest tubes (32F) and 10 had small-bore catheters (<14F) for management of pleural injury. The average length of time the chest tube stayed in place was 3.9 days (minimum 2, maximum 6) for small bore and 4.4 days (minimum 2, maximum 7) for standard chest tubes. There was a statistical trend toward decreased hospital stay and decreased length of time the chest tube was in place when a small-bore chest tube was used.

CONCLUSION: The use of small-bore catheters for management of hydrothorax and pneumothorax have reasonable clinical outcomes when compared with standard large-bore chest tubes after PCNL.

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