A Retrospective Study of Supracostal Puncture in PCNL for the Management of Renal Calculus: Five Year Experience

Abstract

Percutaneous nephrolithotomy has become the cornerstone and one of several procedures developed over the past three decades, marking a positive trend of minimally invasive procedures in modern urology practices. The planning, patient selection and an effective perioperative protocol are crucial for the outcome of PCNL. Although standardized techniques established for the management of renal and upper ureteric calculus is widely used and accepted, we present a study of 500 cases of PCNL by supracostal puncture and its consequences and study the efficacy and safety of a supracostal approach. Objective: To evaluate a supracostal approach for percutaneous nephrolithotomy (s-PCNL) of renal calculus disease, through a retrospective approach and review the efficacy and safety of procedure in comparison to previous studies. Patients and Duration: The retrospective study was conducted by the Dept. of Urology, Mahatma Gandhi Medical College and Hospital, Jaipur. We reviewed the medical records of 500 patients who underwent PCNL by a supracostal access for renal calculus disease from March 2010 to March 2015. METHOD: Patients with stones of various sizes and characteristics in the kidney and upper ureter were included in the study. Patients were studied for safety of the supracostal approach and its associated complications, including operative time and success rate. Mean age of inclusion was 18 to 65 years. RESULTS: There were 500 patients with renal calculus disease. Among them 346(69.2%) were males and 154 (30.8%) females. Calculus were noted in the upper calyx in 157(31.4%), 55(11%) in the middle calyx, 121(24.2%) in the renal pelvis, 47(9.4%) staghorn and partial staghorn calculus, 8(1.6%) in the lower calyx and 112(22.4%) in the upper ureter. Mean age of the patients was 40 years. Estimated time of each procedure was 60-90mins in 162 patients, 90-140mins in 286 patients and more than 140 minutes in 52 patients. Hemothorax developed in 1 patient and was managed by chest drain insertion. CONCLUSION: The present study being retrospective has revealed that supra costal access for management of renal calculus disease is a positive step towards the on-going development and refinement of an already standardized procedure. It avoids solid organ injury at the risk of injury to the pleura and lungs, which are relatively low and can be managed if the procedure is performed under careful guidance; it has reasonably well stone free rates.