Objective: To develop a contemporary complication profile for supracostal upper pole endoscopic-guided prone tubeless "maxi-PCNL" to evaluate the need for change.
Materials/methods: We identified patients undergoing supracostal upper pole percutaneous nephrolithotomy (PCNL) by a single surgeon at a high volume tertiary care stone center between October 2010 and April 2017. Access was obtained with ureteroscopic guidance. The tract was dilated to 30F through radial balloon dilation. All cases were tubeless with ureteral stent for 5-7 days. Preoperative, operative, and postoperative variables were recorded. We recorded need for blood transfusion, angioembolization, thoracentesis and/or chest tube insertion, intensive care unit (ICU) admission, and 30-day readmission.
Results: A total of 375 patients were included. Mean age was 57 years and 59% were women. Mean body mass index was 33 kg/m2. Mean stone burden was 35 mm. The mean operative time was 99 minutes. Median stay was 1 day. There were no complications because of prone position. Postoperative complications included pleural drain (4%), transfusion (6.7%), and angioembolization (0.5%). Transfusion rates were higher in patients with preoperative hemoglobin <10 mg/dL (28% vs 5.1%, p < 0.00001). Rate of ICU admission and readmission was 4.5% and 7.5%, respectively. Transfusion (p ≤ 0.001), pleural drain (p = 0.0002), and readmission (p = 0.030) were associated with ICU admission. Male gender was associated with readmission (10.3% vs 5.5%, odds ratio = 3.1, p = 0.012).
Conclusions: In supracostal upper pole endoscopic-guided prone tubeless Maxi-PCNL, pulmonary complication rate was lower than previously reported and bleeding complications were comparable with mini-PCNL series. Establishing contemporary complication rates will help to assess the need for evolution to mini-PCNL or lower pole supine PCNL.
Keywords: nephrolithiasis; patient positioning; percutaneous nephrolithotomy; postoperative complications.
Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?Int Braz J Urol. 2010 Mar-Apr;36(2):171-6. doi: 10.1590/s1677-55382010000200006. Int Braz J Urol. 2010. PMID: 20450501 Clinical Trial.
Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports.BJU Int. 2005 Oct;96(6):879-83. doi: 10.1111/j.1464-410X.2005.05730.x. BJU Int. 2005. PMID: 16153222
Supracostal tubeless percutaneous nephrolithotomy: a retrospective cohort study.J Endourol. 2013 Mar;27(3):294-7. doi: 10.1089/end.2012.0218. Epub 2012 Dec 5. J Endourol. 2013. PMID: 22973820
Tubeless percutaneous nephrolithotomy--the new standard of care?J Urol. 2010 Oct;184(4):1261-6. doi: 10.1016/j.juro.2010.06.020. Epub 2010 Aug 17. J Urol. 2010. PMID: 20723920 Review.
Comparison of tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: A meta-analysis of randomized trials.Asian J Surg. 2020 Jan;43(1):60-68. doi: 10.1016/j.asjsur.2019.01.016. Epub 2019 Feb 16. Asian J Surg. 2020. PMID: 30782495 Review.
Cited by 1 article
Supine percutaneous nephrolithotomy: tips and tricks.Transl Androl Urol. 2019 Sep;8(Suppl 4):S381-S388. doi: 10.21037/tau.2019.07.09. Transl Androl Urol. 2019. PMID: 31656744 Free PMC article. Review.