title: Supracostal approach in percutaneous nephrolithotomy: experience with 102 cases.
abstract: OBJECTIVE
  To assess retrospectively the safety and efficacy of the supracostal approach in percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Among 862 patients who underwent PCNL between April 1986 and December 1999, supracostal puncture was performed in 102. Their stones were either solitary (66.5%), multiple (15.7%), or staghorn (19.6%). Upper ureteral calculi were the commonest indication (32.4%). The interspace between the 11th and 12th ribs was used in all cases. After tract dilatation with telescopic metal dilators, pneumatic or ultrasound lithotripsy was used for fragmentation.
  
  
  RESULTS
  Complete clearance was achieved in 79.5%. Ten patients (9.8%) had pleural violation in the form of hydrothorax, pneumothorax, or hydropneumothorax. All of these patients were managed successfully by intercostal chest tube drainage.
  
  
  CONCLUSIONS
  Supracostal puncture in a safe and effective approach with acceptable morbidity in selected cases of staghorn, upper ureteral, and upper caliceal calculi.
authors.affiliation: Department of Urology Unit II, Christian Medical College and Hospital, Tamilnadu, India. uro2@cmcvellore.ac.in
authors.forename: N S
authors.initials: NS
authors.lastname: Kekre
authors.forename: G G
authors.initials: GG
authors.lastname: Gopalakrishnan
authors.forename: G G
authors.initials: GG
authors.lastname: Gupta
authors.forename: B N
authors.initials: BN
authors.lastname: Abraham
authors.forename: E
authors.initials: E
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D006872:Hydropneumothorax / Q000209:etiology / Q000628:therapy; D006876:Hydrothorax / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012272:Ribs; D014514:Ureteral Calculi / Q000601:surgery*