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Supracostal access for percutaneous nephrolithotomy: less morbid, more effective
Sudhir Sukumar1, Balagopal Nair, Kumar P Ginil
1Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682 026, India. sukumarsudhi@aims.amrita.edu
International Urology and Nephrology
|September 28, 2007
Summary
Supracostal access for percutaneous nephrolithotomy (PCNL) offers high stone clearance rates. This technique is safe and effective in selected patients, with manageable complications.
Area of Science:
- Urology
- Nephrolithotomy
- Surgical Access
Background:
- Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.
- Supracostal access for PCNL is often avoided due to concerns about potential complications.
Purpose of the Study:
- To evaluate the success and morbidity associated with the supracostal approach for PCNL.
- To determine the safety and efficacy of supracostal access in selected patients.
Main Methods:
- Prospective analysis of 110 patients undergoing supracostal PCNL between 2000 and 2007.
- Data collected included indications, stone clearance rates, and complications.
Main Results:
- High stone clearance rates: 86.4% with monotherapy, 97.3% with secondary procedures.
- Overall complication rate was 11.8%, including hydrothorax/hemothorax, perinephric collection, infection/sepsis, and bleeding.
- Indications included large pelvic, staghorn, and calyceal stones above the 12th rib.
Conclusions:
- Supracostal PCNL provides high stone clearance rates with acceptable morbidity.
- This approach is recommended for selected cases and complications are often manageable conservatively.
