Abstract Objectives: To evaluate a supracostal approach for percutaneous nephrolithotomy
(PCNL) of staghorn calculi through a prospective study and review of
previously reported cases.
Methods: From June 2009 to November 2011, 40 patients with staghorn calculi
were scheduled for supracostal S-PCNL in a prospective study. Of the 40 renal units,
16 (40%) had a complete staghorn and 24 (60%) had a partial staghorn calculus.
Perioperative complications were stratified according to the modified Clavien system.
Univariate and multiple logistic regression analyses were used to determine statistically
significant variables affecting the stone-free rate and development of
complications.
Results: In all, 57 tracts were established in the 40 renal units; 23 (58%) renal
units were approached through one supracostal upper pole calyx, while 13 (33%)
and four (10%) required a second middle- or lower-pole puncture, respectively.
Overall, 78% of patients were rendered stone-free or had clinically insignificant
residual fragments with PCNL monotherapy, and this increased to 88% with auxiliary
procedures. In the logistic regression analysis, a complete staghorn stone was
the only independent variable for residual stones (P = 0.005). There was an overall
complication rate of 38%. Independent variables with an influence on complications
were staghorn stone burden (P = 0.007), and operative duration (P = 0.045).Conclusions
The supracostal upper calyceal approach provides optimum access for the percutaneous removal of staghorn stones. Appropriate attention to the technique and to monitoring before and after surgery can detect thoracic complications, and these can be managed easily with intercostal chest tube drainage, with no serious morbidity. |
