Safety and Efficacy of Supracostal Percutaneous Nephrolithotomy. Our Experience
Keywords:
Percutaneous nephrolithotomy, PCNL, Supracostal access, Renal stones, UrolithiasisAbstract
Aims
To evaluate the safety and efficacy of supracostal access of Percutaneous Nephrolithotomy (PCNL) for the clearance of renal stones.
Methodology
This retrospective study conducted at Hamdard University Hospital, from April 2018-January 2022 included patients > 14 years of age who underwent supracostal PCNL for a large renal or upper ureteral stone, multiple renal stones in > 2 calyces, obstructive stone, or a stone in a single functioning kidney. The preoperative stone burden was measured along the longest dimension and sum for multiple stones. No stone or < 4 mm stone was considered as complete clearance on imaging.
Results
Out of 57, there were 32 males and 25 females with a mean age of 41.51 ± 9.29 years, the duration of surgery was 52.13 ± 8.91 minutes, and the maximum longitudinal length was 3.42 ± 1.12 cm. A total of 49 patients went stone free, eight patients had residual stones, with calyceal residual stones in six, and two had small stone fragments migration in the ureter. Overall complications were seen in nine, with significant bleeding in three, high-grade fever in four, and urinary leakage in two.
Conclusion
Supracostal access for the PCNL in an experienced hand is safe and efficacious in renal stone clearances with few complications.
References
Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN et al (2002) The management of stones disease. BJU Int 89:62–68
Fernstrom I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scan J Urol Nephrol 10:257–259
Goodwin WE, Casey WC, Wolf W (1955) Percutaneous trocar (needle) nephrostomy in hydronephrosis. JAMA 157:891
Sampaio FJ (2000) Renal anatomy. Endourologic considerations. Urol Clin North Am 27:585–607 vii
EAU guidelines on urolithiasis - introduction (2018) Uroweb. Available at: http://uroweb.org/guideline/urolithiasis/ (Accessed: April 16, 2023)
Haider A, Mahmud S Supracostal percutaneous nephrolithotomy, a safe and effective approach: A clinical audit. JPMA. 72. 287–291
Sinha M, Krishnappa P, Subudhi SK, Krishnamoorthy V (2016) Supracostal percutaneous nephrolithotomy: A prospective comparative study. IJU: J Urol Soc India 32(1):45–49
Egilmez T, Tekin MI, Gonen M, Kilinc F, Goren R, Ozkardes H (2007) Efficacy and safety of New-Generation Shockwave Lithotripsy Machine in the Treatment of Single Renal or Ureteral Stones. Experience with 2670 patients. J Endourol l21:23–27
Bird VG, Fallon B, Winfield HN (2003) Practice patterns in the treatment of large renal stones. J Endourol 17:355–363
Skolarikos A, de la Alivizatos G (2005) Rosett e JJ. Percutaneous nephrolithotomy and its legacy. Eur Urol 47:22–28
Lang E, Thomas R, Davis R, Colon I, Allaf M, Hanano A (2009) Risks, advantages, and complications of intercostal vs. subcostal approach for percutaneous nephrolithotomy. Urology 47:751–756
Aslam MZ, Thwaini A, Duggan B, Hameed A, Mulholland C, O'Kane H et al (2011) Urologists versus radiologists made PCNL tracts: The U.K. experience. Urol Res 39:217–221
Rafi S, Haider A, Wasty WH, Hussain A (2017) Safety and efficacyof supracostal access in percutaneous nephrolithotomy: our experience. Pak J Surg 33(4):292–295
Mousavi-Bahar SH, Mehrabi S, Moslemi MK (2011) The safety and efficacy of PCNL with supracostal approach in the treatment of renal stones. Int Urol Nephrol 43(4):983–987
Haider A, Memon WA, el-Khalid S (2018) Comparison of efficacy between supra-costal access and sub-costal access in patients underwent Percutaneous nephro-lithotomy for renal pelvic calculus. Pak J Surg 34(2):110–114
Memon WA, El Khalid S, Haider A, Saulat S, Khan SA, Quddus MB et al (2021) Comparative evaluation of upper versus lower calyceal approach in percutaneous nephrolithotomy (PCNL) for managing renal calculi. JPMA 71:602
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ali Haider, Asadullah Langove, Waqar Ahmed Memon, Uzair Yaqoob, Maria Bhagat (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.