A supracostal approach for percutaneous nephrolithotomy of staghorn calculi: A prospective study and review of previous reports

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).

Conclusion: 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.