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Supracostal percutaneous nephrolithotomy: A prospective comparative study.

Maneesh Sinha1, Pramod Krishnappa1, Santosh Kumar Subudhi1

  • 1Department of Urology, NU Hospitals, Bengaluru, Karnataka, India.

Indian Journal of Urology : IJU : Journal of the Urological Society of India
|March 5, 2016
PubMed
Summary

The supracostal approach for percutaneous nephrolithotomy (PCNL) is feasible, even above the 11th rib. While thoracic complications increased, severe bleeding was minimized by aligning punctures with the calyx.

Keywords:
Angioembolizationintercostal chest drainpercutaneous nephrolithotomysupracostal

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Area of Science:

  • Urology
  • Surgical Techniques
  • Nephrolithotomy

Background:

  • Fear of thoracic complications underutilizes the supracostal approach in percutaneous nephrolithotomy (PCNL).
  • This study compares supracostal (supra 11th and supra 12th rib) versus infracostal approaches for PCNL efficacy and safety.

Purpose of the Study:

  • To evaluate the efficacy and safety of supracostal versus infracostal approaches in PCNL.
  • To compare thoracic complications associated with different rib puncture levels during PCNL.

Main Methods:

  • Prospective study of 700 patients undergoing PCNL from 2005-2012.
  • Patients categorized into infracostal, supra 12th rib, and supra 11th rib puncture groups.
  • Comparison of clearance rates, hemoglobin levels, transfusion, analgesia, hospital stay, and thoracic complications.

Main Results:

  • Overall clearance rate was 78% across all groups.
  • Supracostal groups required significantly more postoperative analgesia.
  • Thoracic complications like angioembolization (0.3%) and chest drain insertion (1.6-2.2%) were low.

Conclusions:

  • The supracostal approach, including supra 11th rib punctures, is feasible for PCNL.
  • Increased thoracic complications are noted with supracostal access, but severe bleeding is preventable.
  • Precise calyceal alignment minimizes the risk of angioembolization.