Supracostal percutaneous nephrolithotomy, a safe and effective approach: A clinical audit

Objective: To emphasize on safety principles through anatomic approach in Supracostal Percutaneous nephrolithotomy (PCNL) Methods: Data of patients who underwent PCNL from June 2004 to August 2014 at the Kidney Centre Karachi, Pakistan were reviewed. Patients above 14 years of age with Supracostal Access were included in study. PCNL was performed in prone position with 'Bull's Eye Technique'. Nephrostomy was placed after completion of the procedure in most cases. Data on demographic details, stone burden, stone clearance with primary PCNL and combination and complications rate was assessed using Modified Clavien Grades 1 through 5. Results: Total 426 patients underwent PCNL. Seventy (70) out of 426 underwent PCNL through Supracostal Approach. Fifty (71.4 %) patients were Stone Free after PCNL and 64 (91.4%) patients were stone free after auxiliary procedures (ESWL, SECONDARY PCNL). The overall complication rate was 4.7% with 3 (4.3%) patients requiring Tube Thoracostomy and 1 (1.4%) each for angioembolisation, pulmonary oedema/ Ventilation and ICU admission due to urosepsis and renal dysfunction. Conclusion: Supracostal PCNL is a safe and effective approach for multiple stones in pelvicalyceal system. Due anatomic consideration can decrease the complication rate. In complex stones with huge burden, an elaborate and thorough counseling regarding delayed clearance and need for auxiliary procedures including secondary PCNL is mandatory.