The Availability of the Supracostal Percutanous Nephrolithotomy / 대한비뇨기과학회지

ABSTRACT

PURPOSE: The supracostal access for percutanous nephrolithotomy (PCNL) is a more useful approach in certain situations according to the position of the kidney, location of the calculi, or configuration of the collecting system. We attempted to assess the availability of supracostal approach based on the experience with supracostal approach in treating the complex renal stone and upper ureteral stones at our institution. MATERIALS AND METHODS: The medical records of 26 patients who underwent sup racostal PCNL procedure, between April 1996 and January 2001 were reviewed retrospectively. Under the general anesthesia, 11th-12th intercostal space was selected for the puncture site. Before the needle was passed between the ribs, the lung was deflated completely to prevent thoracic injury. RESULTS: Mean operating time and hospital stay were 81 minutes and 6.7 days, respectively. The stone-free rate after supracostal PCNL was 73% (19 patients). Extra corporeal shock wave lithotripsy (ESWL) was needed to treat residual stones in 7 patients (26%). After supracostal PCNL followed by ESWL, the stone-free rate rose to 88% (23 patients). Three patients (11%) developed pleural effusion postoperatively, one of whom had chest tube placed, the others improved with conservative management. Except for the pleural effusion, there were no complications such as atelectasis, pnemothorax, hemothorax, or injury to the liver or spleen. CONCLUSIONS: Since the complication rate can be kept to minimum with strict precaution, there is no reason to hesitate supracosatal PCNL, when upper pole punc ture is needed and the desired puncture site is above 12th rib.