Login to Access Video or Poster Abstract: MP75-16
Sources of Funding: None

Introduction

Supracostal access in percutaneous nephrolithotomy (PCNL) may be avoided due to concern for thoracic complications. The objective of the study is to report the safety and efficacy of supracostal access utilizing a tubeless (stent only) PCNL technique.

Methods

From July 2010 to Oct 2016, 70 patients (76 renal units) underwent a supracostal access tubeless PCNL. The study is a retrospective review of their perioperative and postoperative outcomes. All patients underwent a non-contrast CT prior to the surgery. No nephrostomy tubes were left and all patients had a 7F ureteral stent and Foley catheter placed. The nephrostomy sheath was removed with the patient held in expiration, similar to a chest tube, and the incision closed.

Results

Median patient age was 62 years. Median BMI and ASA score was 32.9 kg/m2 and 3, respectively. The median stone size was 20 x 21 mm, and 13 patients had complete staghorn stones. The upper calyx was the site of access in 50 cases. The access was above the 12th and 11th rib in 57 and 12 cases, respectively. The median length of hospital stay was 30 hours. Postoperatively, 48 (63%) patients had no residual fragments (<2 mm) on postoperative imaging. 8 patients underwent an ancillary procedure to clear residual stones (7 URS and 1 ESWL), with an additional 6 patients becoming stone-free after this procedure. Thoracic complications occurred in 2 (2.6%) patients: 1 small pneumothorax that resolved with conservative management, and 1 symptomatic ipsilateral pleural effusion requiring thoracocentesis. Other complications occurred in 9 patients (11.8%) which included bleeding requiring transfusion (1), fever (4), urinary retention (2), and syncope (2).

Conclusions

Compared to historical controls, our approach to upper tract PCNL utilizing a nephrostomy tube free approach resulted in an overall low thoracic complication rate and facilitated hospital discharge.

Funding

None