A Prospective Study of Stone Clearance, Morbidity and Complications of Supracostal Puncture in Percutaneous Nephrolithotomy Pages 1-6
Aparan Parakash Bhat¹, Khandelwal Nikhil², Mahakshit Bhat³, Akshita Bhat⁴ and Bhat Amilal⁴

¹Department of Radidiagnosis, SMS Medical College, Jaipur, India; ²Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India; ³Department of Urology, Dr. S.N. Medical College Jodhpur, Rajasthan, India; 4Department of Surgery, S.P. Medical College Bikaner, Rajasthan, 334003, India

DOI: https://doi.org/10.12970/2310-984X.2020.08.01

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Abstract: Objective: Supra-costal access for PCNL is an established modality to enter the collecting system but potential thoracic complications may limit the adequate usage of this accesss. Objective of the study was to identify the factors leading to supra-costal access, the safety and efficacy of this approach and the potential complications.
Materials and Methods: Patients who underwent supra-costal PCNL between December 2014 and March 2017 for the treatment of renal and ureteric stones were prospectively analyzed. We enrolled 51 patients & their data were analyzed for the stone characteristics, clearance & the complications.
Results: A total of 51 patients (10.64%) out of 47 9 patients had a supra-costal access, the puncture was supra 12th in 47 cases( 92.15%) and supra 11th in 4 (7.84%) . Second access tract was made in 12 cases for complete stone clearance, 46 renal units (90.19 %) became stone free after the primary and ancillary procedures. Hemorrahge was the most common complication in 7.84 % of cases, inter-costal chest drain had to be inserted in one patient (1.96 %) with supra 11th rib access due to pleural collection. All patients recovered well and were asymptomatic on follow-up.
Conclusions: The supra-costal approach provides optimum access, excellent visualization, reasonable operative times along with comparable blood loss and good stone clearance. Although thoracic complications are slightly higher than with a sub-costal approach, but adequate precautions and methodical approach can minimize their incidence. A post-operative X-ray chest should be done in all cases to detect any thoracic complications.

Keywords: Renal stone, PCNL, Supra-costal Access, Complications, Hydrothorax, Haemothorax, Urolithaisis, Haemorrahage. Read more →

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