Is Routine Postoperative Chest Radiography Needed After Percutaneous Nephrolithotomy?

OBJECTIVE To assess whether routine postoperative chest radiography (CXR) is required after percutaneous nephrolithotomy (PCNL) for the detection and possible management of hydropneumothorax. It is the standard for many urologists to obtain routine postoperative CXRs after PCNL to assess for hydropneumothorax. However, it has been our experience that in the few patients who develop hydropneumothorax, the CXR findings almost never affect the clinical management. METHODS A retrospective review was performed of 214 PCNL procedures acquired from 2007 to 2010. The data analyzed included patient demographics, operative data, postoperative CXR findings, and complications. RESULTS We reviewed 214 PCNL procedures, 49% of the 164 patients were men, with a mean age of 48 years and a mean stone burden of 2.4 x 2.5 cm. Renal access was obtained by the urologists in 47% of cases. Renal access was obtained in the upper pole (51%), midpole (26%), and lower pole (23%) through the 11th-12th intercostal space (21%) and below the 12th rib (78%). Renal access was unsuccessful in 2.8%. All patients underwent postoperative CXR. Only 2 patients (1%) had a hydropneumothorax, and both had clinical symptoms. One patient's postoperative CXR findings were minimal pleural effusion only. Both patients were treated with tube thoracostomy. The mean hospital length of stay was 1.6 days, and the mortality rate was 0.5%. CONCLUSION Routine postoperative CXR is not needed after PCNL. Obtaining selective CXR when a recognized intraoperative hydropneumothorax has occurred, the physical examination reveals an abnormality, or the patient experiences respiratory difficulties in the postoperative period is safe, cost-effective, and reduces unnecessary radiation exposure to the patients. UROLOGY 79: 791-795, 2012. (C) 2012 Elsevier Inc.