title: Supracostal Punctures for PCNL: Factors that Predict Safety, Success and Stone Free Rate in Stag Horn and Non-Stag Horn Stones: A Single Centre Experience and Review of Literature.
abstract: BACKGROUND
  Supra-costal Percutaneous Nephrolithotomy (PCNL) procedure has now become an established standard of care in patients with renal stone disease, in terms of morbidity, stone clearance, duration of stay and shorter convalescence period. Gone are the days when supracostal punctures were considered to be associated with a high morbidity. With increased expertise gained in performing multiple punctures and further refinements in focusing techniques, more and more of these procedures are being performed with an intention to achieve a maximum stone clearance with least morbidity.
  
  
  OBJECTIVE
  To prospectively analyze the various factors that predict the safety, efficacy and stone clearance rate in patients who have undergo supracostal punctures for PCNL procedures.
  
  
  METHODS
  Three hundred seventy six patients underwent PCNL for renal stones. Ninety two (n=92) of them needed supra-costal puncture. All patients were subdivided into groups 1 and 2 based on the size, location of the stone and the stone burden. In all, 132 tracts were established.
  
  
  RESULTS
  About 83% of patients achieved a complete stone free rate after initial PCNL. Stones more than 3 centimeters were found to be associated with significant residual stones. Radio opacity under image intensifier also had a significant impact on the ultimate stone free status. About 23% of those (n=5/22) who needed longer duration of surgery had a clinically significant residual stones, needing ancillary procedures. Fifteen patients (16%) had complications related to the procedure, of which 13 were in group 1 (87%). High percentage of complications in patients with larger stone burden was found to be statistically significant. In about 76% (n=70), the procedure required only less than 90 minutes. Also, in those 22 patients in whom the duration of procedure exceeded 90 minutes, 12 of them had complications, with a p-value of <0.0001.
  
  
  CONCLUSIONS
  Supra-costal punctures are safe and effective options in a selected group of patients. The overall results are almost on par with that of the infra costal punctures, with an acceptable morbidity.
authors: Assistant Professor, Department of Urology, Sri Ramachandra Medical College , Chennai, Tamilnadu, India .
authors: Hariharasudhan
authors: H
authors: Sekar
authors: Professor, Department of Urology, Sri Ramachandra Medical College , Chennai, Tamilnadu, India .
authors: Sriram
authors: S
authors: Krishnamoorthy
authors: Professor, Department of Urology, Sri Ramachandra Medical College , Chennai, Tamilnadu, India .
authors: Natarajan
authors: N
authors: Kumaresan
authors: Professor of Urology, Department of Urology, Sri Ramachandra Medical College , Chennai, Tamilnadu, India .
authors: Venkat
authors: V
authors: Ramanan
keywords: Hematuria; Hydrothorax; Nephrostomy; Renal Calculus