The Safety and Efficacy of Supracostal punctures in Percutaneous Nephrolithotomy (PCNL)

Shrestha PM*, Kunwar AK*


Introduction: Many urologists hesitate in using supracostal punctures because of the potential of chest complications. The aim of this study is to study the morbidity and outcome of supracostal access performing Percutaneous Nephrolithotomy (PCNL).

Method: A total of 156 renal units were treated with PCNL from February 2011 to April 2014. The indications for supracostal punctures were staghorn, middlecalyceal stones, pelvic stones, complex inferior calyceal calculi, stones in the upper calyx and upper ureteric stone. The urologist under C-arm fluoroscopic guidance in the prone position made all the punctures.

Result: The intercostal space between 11th and 12th rib was used except four patients in whom the puncture was made supra 11th rib (between 10th and 11th intercostal space). Six patients developed hydrothorax, out of which three needed chest tube insertion and three was treated conservatively, by just simple needle aspiration and observation. One developed hemothorax, which required chest tube insertion and transfusion. Two developed minimal pneumothorax with blunting of costophrenic angle, which was treated conservatively. The lung or any other viscera injury was not observed in any case. Hospital stay was not significantly prolonged as a result of the pleural injuries. Most punctures were, a single supracostal superior or middle posterior calyceal access 78.20% (122/156), except for most staghorn needed multiple tracts 21.79% (34/156).

Conclusion: The supracostal access do have high clearance rates with acceptable complications, it should be adapted whenever needed and should not be avoided due to fear of chest complications.

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