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WCE 2017: Supracostal Access Tubeless Percutaneous Nephrolithotomy: Minimizing Complications

Vancouver, Canada (UroToday.com) Dr. Sourial et al. present a retrospective study of 76 renal units from 70 patients who underwent percutaneous nephrolithotomy with supracostal access. Only a 7F ureteral stent and Foley catheter were left postoperatively; nephrostomy tubes were removed at end-expiration. The median age was 62 years. Median BMI was 33 kg/m2. Complete staghorn stones were identified in 14 renal units (18%). The site of access was the upper calyx in 50 renal units (66%) and was above the 12th and 11th ribs in 63 (83%) and 12 (16%) of renal units, respectively. Access was gained above the 10th rib in one renal unit.

Median length of hospital stay was 30 hours (range: 28-32 hours). Complications developed in 11 patients (16%). Of those, thoracic complications occurred in 2 patients (3%). This compares favorably with the reported rate of thoracic complications of 2.8% to 22.2% during supracostal tubeless PCNL. More specifically, one patient developed a small pneumothorax that resolved with conservative management, while the other patient developed a symptomatic pleural effusion requiring thoracocentesis. Other complications included bleeding requiring transfusion, fever, urinary retention, and syncope.

These authors deserve applause for challenging the prevailing notion that the higher the access, the higher the rate of complications, and even more so for presenting the complications they encountered. However, this study alone is unlikely to overcome the reluctance of urologists to use a supracostal approach. As shown in this study, the fear of thoracic complications is definitely not unfounded. However, removal of the access sheath at end-expiration, along with placement of a ureteral stent, appears to minimize the rate of thoracic complications.

Presented by: Michael Sourial, MD

Authors: Michael Sourial, Nathaly François, Geoffrey Box, and Bodo E. Knudsen – The Ohio State University Wexner Medical Center, Columbus, OH, USA
Affiliation: The Ohio State University Wexner Medical Center

Written by: Michael Owyong (@ohyoungmike), LIFT Fellow, Department of Urology, UC Irvine Medical Center, Orange, CA, USA at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.