title: Safety and efficacy of supracostal access in tubeless percutaneous nephrolithotomy.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of supracostal access in tubeless percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  From September 2004 to November 2005, tubeless PCNL using supracostal access was done for 72 patients at our institute. Patients requiring more than two percutaneous tracts or with significant intraoperative bleeding or residual stone burden were excluded from the study. The outcome of these patients was compared with that of a historic cohort of similar patients having supracostal access with routine placement of a nephrostomy tube. The two groups had comparable demographic data.
  
  
  RESULTS
  The differences in the mean drop in hemoglobin concentration, transfusion requirement, and complication rate in the two groups were not statistically significant, with three patients in the study group and four patients in the control group requiring blood transfusion. Patients undergoing tubeless PCNL required less analgesia (P = 0.000) and were discharged a mean of 19 hours earlier (P = 0.000) than those in the control group. Complete stone clearance was achieved in 90.27% of the renal units in the study group and 86.11% of the renal units in the control group. Two patients in the study group and three patients in the control group had postoperative hydrothorax, all of whom, except for one in the control group, were managed conservatively.
  
  
  CONCLUSIONS
  Supracostal access in tubeless PCNL appears to be feasible, safe, and effective, offering the advantages of a lower analgesic requirement and shorter hospital stay without increasing thoracic complications. Studies with larger numbers of patients are needed to confirm these initial findings.
authors.affiliation: Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India. drhemendrashah@yahoo.co.in
authors.forename: Hemendra N
authors.initials: HN
authors.lastname: Shah
authors.forename: Hemendra
authors.initials: H
authors.lastname: Shah
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Hegde
authors.forename: Sunil
authors.initials: S
authors.lastname: Hegde
authors.forename: Jignesh N
authors.initials: JN
authors.lastname: Shah
authors.forename: Jignesh
authors.initials: J
authors.lastname: Shah
authors.forename: Manish B
authors.initials: MB
authors.lastname: Bansal
authors.forename: Manish
authors.initials: M
authors.lastname: Bansal
mesh_terms: D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome