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- Title
Safety and efficacy of supracostal access in percutaneous nephrolithotomy: our experience.
- Authors
Rafi, Sobia; Haider, Ali; Wasty, Wajahat H.; Hussain, Anees
- Abstract
Objective: To evaluate the safety and effi cacy of the supracostal access for percutaneous nephrolithotomy (PCNL). Material and Methods: From May 2015 till March 2017, 41 patients underwent PCNL, in 26 (63.4%) patients the collecting system was accessed supracostally above the 12th rib. Single tract was used in 24 (93%) patients and 2 (07%) patients required a second tract. Data were analyzed for indications of supracostal access, stone clearance and complications. Th e indications for a supracostal access were stag horn stones (46.15%), pelvis stones (34.6%), upper calyceal/diverticular stones (15.4%) and upper ureteric stones (3.85%). Post-operative stone clearance was assessed with x-ray KUB for radiopaque stones and ultrasound for radiolucent stones. Stone clearance was defi ned as residual stone size less than 0.4cm. Results: Out of 26 patients, who underwent supracostal PCNL, 15 (57.7%) patients were males while 11 (42.3%) were females. Th e mean ages of patients were 37.81±9.58 years. Overall duration of surgery was 46.13±8.91 minutes. Th e mean stone size (maximum longitudinal length) was 3.28±1.12 cm. satisfactory stone clearance was seen in in 23 patients (88.5%). 3 (11.5%) patients required one session each of ESWL for residual stones. Complications were seen in fi ve patients (19.2%). 2 patients had signifi cant bleeding with 1 patient requiring angio-embolization (3.8%). 2 (7.7%) patients developed high grade fever, required prolonged intravenous antibiotics and anti-pyretics. 1 (3.8%) patient developed urinary leakage from puncture site which was managed conservatively. Other major complications like pneumothorax and other visceral injury were not observed. Conclusion: Supracostal access above the twelft h rib for PCNL provides a safe access and has the advantage of managing complex renal, diverticular/upper calyceal and proximal ureteric stones.
- Subjects
PERCUTANEOUS nephrolithotomy; SURGICAL complications; LUNG biopsy; PNEUMOTHORAX; TREATMENT duration; THERAPEUTIC embolization
- Publication
Pakistan Journal of Surgery, 2017, Vol 33, Issue 4, p292
- ISSN
0258-8552
- Publication type
Article