Diagnosis and Management of Thoracic Complications of Percutaneous Renal Surgery

Percutaneous renal surgery is the recommended treatment for large renal stones and plays a vital role in treating a variety of other urologic indications. However, because of the percutaneous approach into the kidney, there are specific thoracic complications that should be well understood by those undertaking this approach. The superior portions of the kidneys are typically covered by pleura posteriorly. This anatomic relationship creates the possibility for pleural injury during percutaneous access into the kidneys. Pleural injury can subsequently result in pathologies such as hydrothorax, pneumothorax, empyema, nephropleural fistula, and hemothorax. In this chapter we discuss the specifics of these complications as well as their diagnosis and management. We present an updated and relevant review of the current literature regarding these complications and present evidence-based recommendations for their management.