IP Journal of Urology, Nephrology and Hepatology Science

The various access for renal calyx in PCNL – A urologist perspective– Study conducted at a multi-speciality hospital

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Article Type : Original Article

Author Details: Prashanth Adiga K.*,Omar Shah,Reshmina Chandni Clara D'souza,Sahil Sheikh,Amith V L D' Souza

Volume : 1

Issue : 2

Online ISSN : XXXX

Print ISSN : XXXX

Article First Page : 22

Article End Page : 24

Abstract

Introduction: Renal stones have been a common & disabling surgical problem.¹ Nephrolithiasis is a very common disease, with an increasing incidence and prevalence and a significant economic impact associated with its treatment.² The surgical management of kidney stone disease has changed dramatically over the past 25 years, as a result of revolutionary technologic and treatment advances.³ Many patients need to undergo invasive surgery and undergo prolonged recovery. Until the last 2 decades, open surgery for kidney stones was common.
Advances in surgical technique and technology have allowed the urologist to remove calculi percutaneously with increasing efficiency. In PCNL widely preferred is the infracostal approach. Supracostal access in general and supra11th access in particular, continues to be underutilized due to an unfounded fear of thoracic complications though the view of the renal calyceal system is better with this approach.
In view of the above said we in our study evaluated theprospectively safety, efficacy and complications of supracostal access for PCNL.
Material and Methods:The study was a Prospective study that was conducted at the department of Urology, January 2016- September 2018 on patients who were planned for PCNL on cases aged between the Age of 18 years and 55 years with unilateral uncomplicated renal calculi.
Exclusion criteria:Patients who have had undergone intervention procedures for renal calculi Patients with diabetes Mellitus and those with bleeding disorders, Contraindications for anesthesia.
Initially with ultrasound KUB and then IVU/CT KUB to know the exact location of calculi, pelvicalyceal anatomy and dilatation, lie of the kidney, relationship with ribs and surrounding organs.
Informed written consent was taken in all patients. Antibiotics were given at the time of induction of anaesthesia. Type of puncture either supracostal or subcostal was analyzed preoperatively and also intra-operatively after RGP in prone position under C-arm. All cases were done under general anaesthesia.
Results and analysis:The demographic details were was follows the mean age was 49 standard deviation + 2.08years in the subcoastal group and 48 standard deviation + 2.18years.
Overall males predominated the study we had 42 males and 2 females. Between the two groups there was no statistical difference in terms of age, sex, pre-operative characteristics like mean stone size, the ASA status hence the two groups were comparable.
In the present study renal access in supracostal group the access was done both in the upper calyx 20 cases and mid calyx in one case. In the infracoastal group 19 cases were through the lower calyx and on three cases the access was achieved through the mid calyx.
We observed that the need for blood transfusion, pleural and pulmonary complications. , mean operating time was higher in the supra -coastal group but the duration of post-operative hospitalization , the need for post operative analgesia and the mean Vas score did not differ between the groups with a p value of more than 0.05.
Conclusions: in order of access of PCN Supra -costal access method is an effective and safe procedure with acceptable morbidity.

Keywords: PCNL, Nephrolithiasis, Supracostal, complications.

Doi No:-10.18231