EVALUATION OF SAFETY PROFILE OF SUPRACOSTAL ACCESS IN PERCUTANEOUS NEPHROLITHOTOMY.

Aims and objectives:- To evaluate the safety and efficacy ofsupracostal puncture in PCNL. Materials and methods:- This is a retrospective study conducted in the department of Urology at NIMS, Hyderabad from August’2013 to July’2015. A total of 68cases who underwent supracostal puncture during this period were studied. The indications of supracostal approach in our cases were staghorn and complex inferior calyceal stones, and stones in the upper calyx or the upper ureter. All punctures were made by the urologist under C-arm fluoroscopic guidance in the prone position. After tract dilatation with telescopic metal dilators, pneumatic or ultrasound lithotripsy was used for fragmentation. The operative time, success rate, hospital stay, and complications were evaluated. Results:- Among 68 cases studied 49 were males and 19 were females withstaghorn being most common indication for supracostal puncture. Only 15 cases needed additional puncture for complete clearance. Post-operative complications were noted in 10cases in which 5 presented with sepsis. Conclusion:- Supracostal approach can be ideal for many clinical situations including Stones in more complicated renal systems, such as an upper pole complex lower pole configurations may be more amenable to a supracostal upper calyx approach. Supracostal access above the 11th rib should be avoided when possible. With a good understanding of the anatomy surrounding the upper pole of the kidney and attention to a few technical considerations during the procedure, access through a supracostal approach can be performed safely and efficiently.