Safety and Efficacy of Supracostal Approach for Percutaneous Nephrolithotomy (A Prospective Study)

Abstract
Background: The management of large kidney stones is still one of today's topics in endourology. Supracostal Percu-taneous Nephrolithotomy (PCNL) is found to be a highly effective procedure in treatment of renal calculi. However, many factors are affecting the safety and efficacy of the procedure.
Aim of Study: The aim of this study was to evaluate the factors that affect the safety and efficacy of supracostal PCNL in kidney stones.
Patients and Methods: Fifteen patients with renal calculi underwent supracostal percutaneous nephrolithotomy either with single access or multiple accesses. Pre-operative, operative and post-operative data were reported. Multivariate analyses as well as univariate analyses were used to investigate the effects of different variables on residual stones and blood transfusion rate. These factors include age, sex, laterality, body mass index, history of ipsilateral open renal surgery, operative time, and stone density.
Results: The study included 15 patients with mean stone size is 2.5cm±0.6, all stones were radiopaque with mean HFU 969±134, R, 4 patients had upper calyceal stone (26.7%), 9 patients had stone pelvis and upper calyx (60%), and 2 patients had complex stone. (13.3%), 9 patients had multiple kidney punctures (60%) and 6 patients had single kidney puncture (40%), one case had positive signs of hydrothorax intraoper-atively (6.7%) by fluoroscopy, one case had pelvic perforation (6.7%), mean operative time was 105 minutes ±0.23, post-operative chest X-ray revealed positive signs in 2 cases (13.4%) with mild symptoms and needed no intervention, 1 case had significant post-operative bleeding (6.7%) and needed blood transfusion, mean hospital stay time was 2.7 days ±1.8, residual stones were encountered in 4 cases (27%).
Conclusion: Supracostal PCNL is a safe and effective procedure for kidney stones more than 2cm. The stone free rate in the study was related mainly to patient’s comorbidities like BMI, stone size and site. Chest complications needed intervention in only one case, later on was completely free.