Outcomes of modified Supine Supra-costal Percutaneous Nephrolithotomy: A Prospective Cohort Study

Abstract

Background: Supracostal puncture could be the most effective method for accessing the upper pole posterior calyx, which is considered the ideal route for staghorn and large complex renal stones. We aimed at this work to assess the efficacy, safety as well as the outcome of supine supracostal Percutaneous Nephrolithotomy (PNL) in managing the renal calculi. Methods: we carried out this prospective cohort study on 25 patients with renal stones larger than 2 cm who underwent percutaneous nephrolithotripsy as indicated and attended the Urology Outpatient clinic, they underwent PCNL through supra costal puncture in supine position. Postoperative chest X-ray, Kidney, ureter as well as bladder (KUB) x ray, in addition to pelviabdominal ultrasonography were done for all patients. Results: The incidence of postoperative complications was as follows: Out of 25 patients, 3 patients (12%) developed hydrothorax. Significant intraoperative bleeding occurred in 12% of cases, one of which required blood transfusion. The success rate was 76 % at 24 hours and raised to 84% at four weeks as 2 cases passed the stone spontaneously, two cases 8.0% had 2nd look PNL, and two cases 8.0% needed Extracorporeal Shock Wave Lithotripsy (ESWL). We found no significant injuries to adjacent organs, attributed to the use of preoperative helical CT and careful puncture techniques. Conclusion: The supracostal approach in PCNL in modified supine position is a safe procedure and effective in case of upper calyceal and staghorn stones. It demonstrates accepted stone-free rates, with considerable complication rates, so the approach must be put in consideration.