Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Upper pole calculi constitute 15% of all caliceal stones.
• Extracorporeal shockwave lithotripsy (SWL) has improved management, but some cases remain challenging.
• Features like large diameter (>1.5 cm), infundibular narrowing, and morbid obesity can limit SWL efficacy.

Purpose of the Study:

• To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) for large or complex upper pole calculi.
• To assess the suitability of the supracostal approach for direct and efficient access to upper pole calices.

Main Methods:

• Twenty-one patients with large/complex upper pole calculi underwent supracostal PCNL.
• Procedures involved direct upper pole caliceal access, tract dilation (up to 26 F), and stone fragmentation (ultrasonic/pneumatic).
• Patient characteristics included staghorn calculi, horseshoe kidney, and morbid obesity.

Main Results:

• Supracostal PCNL was effective for large (7-40 mm) and complex upper pole calculi.
• Minimal blood loss and no intrathoracic complications were observed.
• One patient required secondary SWL for residual fragments.

Conclusions:

• Supracostal PCNL provides direct and efficient access for treating challenging upper pole calculi.
• This approach is particularly effective for large, complex stones and in morbidly obese patients.
• Supracostal PCNL is a safe and effective treatment option for upper pole renal calculi.