title: Upper-pole puncture in percutaneous nephrolithotomy: a retrospective review of treatment safety and efficacy.
abstract: OBJECTIVE
  To review the safety and efficacy of supracostal puncture during percutaneous nephrolithotomy (PCNL) for renal calculi.
  
  
  METHODS
  Over a 12-year period, 66 patients had either an upper-pole puncture alone or combined with middle- or lower-pole puncture during PCNL for renal calculi. All punctures were made by an experienced uroradiologist and were either supra- or subcostal. We retrospectively reviewed all case notes and radiographs to determine stone-clearance rates and complications associated with the site and number of punctures.
  
  
  RESULTS
  There was an overall stone-free rate of 78% with upper-pole puncture alone or combined with middle- or lower-pole puncture. There was a 3% thoracic complication rate with upper pole punctures, and an overall complication rate of 30% for both thoracic and non-thoracic complications.
  
  
  CONCLUSIONS
  Upper-pole puncture in PCNL is associated with minimum morbidity if done by an experienced urologist or radiologist. The stone-free rate appears to be more dependent on stone size and complexity than the site of puncture.
authors.affiliation: The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, Scotland, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Raza
authors.forename: Sami
authors.initials: S
authors.lastname: Moussa
authors.forename: Gordon
authors.initials: G
authors.lastname: Smith
authors.forename: David A
authors.initials: DA
authors.lastname: Tolley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011677:Punctures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome