Supracostal Puncture in PCNL: Our Experience

Percutaneous nephrolithotomy has become the cornerstone and one of several procedures developed over the past decades. The planning, patient selection and an effective perioperative protocol are crucial for the outcome of PCNL. Although many standardized techniques established for the management of renal and upper ureteric calculus, supracostal approach is widely used and accepted. The objective is to evaluate and compare supracostal and lower calyceal approach for percutaneous nephrolithotomy (S-PCNL) in renal calculus disease, through a retrospective approach. The retrospective study was conducted by the Dept. of Urology, Mahatma Gandhi Medical College and Hospital, Jaipur. We reviewed the medical records of 600 patients who underwent PCNL by a supracostal access for renal calculus disease from March 2010 to June 2016. Patients with stones of various sizes and characteristics in the kidney and upper ureter were included in the study. Patients were studies for safety of the supracostal approach and its associated complications, including postoperative hospital stay, operative time and success rate. There were 600 patients with renal calculus disease. Among them 396 (69.2%) were males and 204 (30.8%) females. Calculus were noted in the upper calyx in 187 (33.4%), 113 (18.6%) in the middle calyx, 107 (17.4%) in the renal pelvis, 56 (7.2%) in the lower calyx and 137 (23.4%) in the upper ureter. Mean age of the patients was 40. Estimated time of procedures was 60 – 90mins in 162 patients, 90 – 140mins in 336 patients and more than 140 minutes in 102 patients. Hemothorax developed in 1 patient and was managed by chest drain insertion. The present study being retrospective has revealed that supra costal access for management of renal calculus disease is a positive step towards the on-going development and refinement of an already standardized procedure. It carries the risk of injury to the pleura and lungs, which are relatively low and can be managed if the procedure is performed under careful guidance.