Abdominal flank bulging is a known sequela after flank incision performed for a variety of renal, vascular, and neurosurgical procedures. The incidence of incisional flank bulge in renal surgery ranges from 3 to 49%, and although it is not considered a major complication, it has a negative effect on the quality of life of the patients. Damage to the intercostal nerves during surgery via a flank incision can be caused by division, retractor pressure, a suture, or compression by fibrous tissue during the wound healing process. However, with the advent of percutaneous minimally invasive techniques in renal surgery, this denervation injury has been scarcely described in the literature. We report a rare complication of flank bulge after supracostal percutaneous nephrolithotomy in three patients. We highlight the potential importance of intercostal nerve anatomy in preventing neurologic injury as a key pathogenetic cause of the bulging.
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