Safety and Efficacy of Supracostal Percutaneous Nephrolithotomy. Our Experience

Aims To evaluate the safety and efficacy of supracostal access of Percutaneous Nephrolithotomy (PCNL) for the clearance of renal stones. Methodology This retrospective study conducted at Hamdard University Hospital, from April 2018-January 2022 included patients > 14 years of age who underwent supracostal PCNL for a large renal or upper ureteral stone, multiple renal stones in > 2 calyces, obstructive stone, or a stone in a single functioning kidney. The preoperative stone burden was measured along the longest dimension and sum for multiple stones. No stone or < 4 mm stone was considered as complete clearance on imaging. Results Out of 57, there were 32 males and 25 females with a mean age of 41.51 ± 9.29 years, the duration of surgery was 52.13 ± 8.91 minutes, and the maximum longitudinal length was 3.42 ± 1.12 cm. A total of 49 patients went stone free, eight patients had residual stones, with calyceal residual stones in six, and two had small stone fragments migration in the ureter. Overall complications were seen in nine, with significant bleeding in three, high-grade fever in four, and urinary leakage in two. Conclusion Supracostal access for the PCNL in an experienced hand is safe and efficacious in renal stone clearances with few complications.