Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Renal stone disease continues to be one of the most frequently encountered disorders in urological practice. Over the last several decades, the epidemiological profile of stone disease has evolved considerably, with increasing prevalence across both sexes and across a wider age spectrum. Simultaneously, major progress in endourology and minimally invasive stone surgery has transformed the management of renal calculi. Among the available treatment modalities, percutaneous nephrolithotomy (PCNL) has emerged as the standard procedure for large, complex, and staghorn renal stones. In selected cases, especially those involving staghorn calculi, upper calyceal stones, and complex proximal ureteric stones, supracostal access offers a more direct tract to the collecting system and may facilitate better stone clearance. However, the supracostal approach has traditionally been viewed with caution because of the perceived risk of thoracic complications. To prospectively evaluate the safety and efficacy of supracostal puncture in patients undergoing PCNL for renal and upper ureteric calculi. This prospective observational study was conducted in the Department of Urology, The Oxford Medical College Hospital and Research Centre, on 32 patients who required supracostal access for PCNL between July 2022 and January 2023. All procedures were performed using access above the 12th rib under fluoroscopic guidance. Clinical, radiological, intraoperative, and postoperative parameters were recorded. The primary outcome was stone clearance. Secondary outcomes included complications, need for additional puncture, ancillary procedures, and duration of hospital stay. The mean age of the study population was 39.69 years, with an age range of 17 to 61 years. Of the 32 patients, 21 had left-sided calculi and 11 had right-sided calculi. Staghorn calculi were present in 28 patients (87.5%), while 4 patients (12.5%) had upper ureteric stones. The mean stone size was 28.56 mm. Complete stone clearance was achieved in 28 patients (87.5%). Significant residual calculi were noted in 4 patients (12.5%), of whom one patient required adjunctive ESWL and three were followed up conservatively. Supracostal puncture was the sole access in 27 patients, while an additional puncture was needed in 5 patients. The mean postoperative hospital stay was 5.53 days. Postoperative complications occurred in 6 patients (18.75%), including haemothorax in 2 patients, pelvic perforation in 1 patient, and postoperative sepsis in 3 patients. No patient developed pneumothorax or visceral injury. Supracostal PCNL is a safe and effective procedure in selected patients with complex renal stone disease. When performed by experienced surgeons with appropriate preoperative planning and meticulous technique, supracostal access can achieve high stone clearance with acceptable morbidity. The findings of this study support the use of supracostal puncture in appropriately chosen cases requiring a direct and efficient tract to the collecting system.
How to cite this article:
S. Sukesh Sindhey, B. Praveen and Mohammed Mujtaba Hussain. Supracostal Percutaneous Nephrolithotomy in the Management of Renal Calculi: A Prospective Observational Study.
DOI: https://doi.org/10.36478/10.36478/makrjms.2023.5.797.805
URL: https://www.makhillpublications.co/view-article/1815-9346/10.36478/makrjms.2023.5.797.805