EVALUATION OF SAFTEY AND EFFICACY OF SUPRACOSTAL APPROACH IN PERCUTANEOUS NEPHROLITHOTOMY

Abstract

The evaluation of safety and efficacy of supracostal percutaneous nephrolithotomy was the aim of our prospective non randomized study conducted during the period from March 2014 till September 2017 in urology department, Ain shams and Misr University for science and technology hospitals. The study included 30 patients comprising 24 males (80%) and 6 females (20%). Their mean age was 33.3 ± 9.1 and the range is (20 – 52). The mean operative time ranged between 50 minutes and 120 minutes. We achieved a 94% stone-free rate. The mean hospital stay was 3.6 days (2-5). 18 procedures (60.0%) were completed with one puncture and 12 procedures (40.0%) was completed with two punctures at least one of them was supracostal. one procedure (3.3%) done with supra 11th rib (between 11h rib and10th rib) while 29 procedures (96.7%) through supra 12th rib approach (between12th rib and11th rib). Supracostal access above 11th rib should be done only by surgeons with expertise in obtaining the access and when the benefits outweigh the increased risk of intrathoracic complications. A chest X ray immediately post operative is mandatory in all patients treated with this approach for early detection of any complications. In conclusion, the supracostal approach was found to be effective as well as safe, with acceptable complications. The supracostal approach offers the advantages of a short direct tract