In this study, we aimed to evaluate the efficiency and safety of supracostal and subcostal approaches during miniaturized percutaneous nephrolithotomy (mPNL). In two tertiary academic centers, we retrospectively analyzed the charts of patients who had undergone mPNL between January 2011 and June 2015 for the treatment of renal stones. Enrolled in the study were 49 patients who had access through the supracostal area (Group 1) and, to serve as controls, 49 patients who were accessed through the subcostal area (Group 2). To avoid potential bias between the groups, the patients were retrospectively matched one-on-one with respect to age, gender, body mass index, ASA score, and size and number of stones. The presence of upper calyx stones and distorted lower calyx anatomy were the most common reasons for performing supracostal access (57.1 and 28.6%, respectively). Access through 11–12 intercostal space was performed in 46 patients (93.9%), and the other three supracostal accesses (6.1%) were performed through the 10–11 intercostal area. The complication rates were 14.3% in Group 1 and 16.3% in Group 2 (p = 0.952). Final stone-free status had increased to 89.8 and 87.8% in Groups 1 and 2, respectively (p = 0.942). Our study demonstrated that mPNL resulted in acceptable stone-free rates whether accessed through either the supracostal or subcostal areas. Moreover, the supracostal approach with mPNL had no negative effect on any intraoperative and postoperative parameters, nor did it increase complication rates.
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Ozgor F.—Project development and manuscript writing. Yanaral F., Ozgor F.—Data analyzing. Tepeler A.—Manuscript editing. Basibuyuk I., Kayali Y.—Data collection. Kucuktopcu O.—Manuscriptediting. Tepeler A.—Data collection and data management. Yanaral F., Kayali Y.—Data management. Binbay M.—Project development and manuscript editing.
Compliance with ethical standards
Conflict of interest
Informed consent was obtained preoperatively from all of our patients which were included in our study.
Mirheydar HS, Palazzi KL, Derweesh IH, et al (2013) Percutaneous nephrolithotomy use is increasing in the United States: an analysis of trends and complications. Endourol 27:979–983CrossRefGoogle Scholar
Raza A, Moussa S, Smith G et al (2008) Upper pole puncture in percutaneous nephrolithotomy: a retrospective review of treatment, safety and efficacy. BJU Int 101:599–602CrossRefPubMedGoogle Scholar
Mishra S, Sharma R, Garg C et al (2011) Prospective comparative study of mini perc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 108:896–899PubMedGoogle Scholar
Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C (2007) Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology 269:603–607CrossRefGoogle Scholar
El-Nahas AR, Shokeir AA, El-Assmy AM et al (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 177:576–579CrossRefPubMedGoogle Scholar
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
Gupta R, Kumar A, Kapoor R et al (2002) Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy. BJU Int 90:809–813CrossRefPubMedGoogle Scholar
Radecka E, Brehmer M, Holmgren K et al (2003) Complications associated with percutaneous nephrolithotripsy: Supra-versus subcostal access. Acta Radiol 44:447–451PubMedGoogle Scholar
McAllister M, Lim K, Torrey R et al (2011) Intercostal vessels and nerves are at risk for injury during supracostal percutaneous nephrostolithotomy. J Urol 185:329–334CrossRefPubMedGoogle Scholar
Munver R, Delvecchio FC, Newman GE et al (2001) Critical analysis of supracostal access for percutaneous renal surgery. J Urol 166:1242–1246CrossRefPubMedGoogle Scholar
Shaban A, Kodera A, El Ghoneimy MN et al (2008) Safety and efficacy of supracostal access in percutaneous renal surgery. J Endourol 22:29–34CrossRefPubMedGoogle Scholar
Cheng F, Yu W, Zhang X et al (2010) Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol 24:1579–1582CrossRefPubMedGoogle Scholar
Lojanapiwat B, Prasopsuk S (2006) Upper pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol 20:391–395Google Scholar
Lang E, Thomas R, Davis R et al (2009) Risks, advantages, andcomplications of intercostal vs subcostal approach for percutaneous nephrolithotripsy. Urology 74:751–755CrossRefPubMedGoogle Scholar
Bjurlin MA, O’Grady T, Kim R, Jordan MD, Goble SM, Hollowel MP (2012) Is routine postoperative chest radiography needed after percutaneous nephrolithotomy? Urology 79:791–795CrossRefPubMedGoogle Scholar
Ogan K, Corwin TS, Smith T et al (2003) Sensitivity of chest fluoroscopy compared with chest CT and chest radiography for diagnosing hydropneumothorax in association with percutaneous nephrostolithotomy. Urology 62:988–992CrossRefPubMedGoogle Scholar