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Upper-pole infra-costal access for supine percutaneous nephrolithotomy: Advantage or risk?

Objective: There are still disagreements in choosing a better approach to establish a percutaneous tract for percutaneous nephrolithotomy (PCNL), between supine and prone positions. The aim of this study is to investigate the safety, efficacy, and practicability of treating upper-pole renal stones, using an infra-costal puncture in both prone and supine positions. Materials and Methods: Fifteen patients underwent infra-costal puncture for the percutaneous treatment of upper-pole stones at our institution over a 3-year period. Seven patients underwent a prone procedure and six had a supine PCNL. All punctures were undertaken by two consultant urologists. Stone clearance was assessed with a plain X-ray kidney-ureter-bladder on postoperative day 1. We retrospectively analyzed our prospectively maintained database to assess stone clearance, complications, and length of stay of these patients. Results: The overall stone-free rate was 93.3% (all but one patient). One hundred percentage of the prone group were stone free following the procedure. Nearly 87.5% of the supine group had a complete clearance. Complications and length of stay were comparable for both groups. Almost 25% of the supine group and 14% of the prone group required transfusion. The postoperative pyrexia rates were similar for both groups. The overall complication rate was 26.7% (n = 4) – one case of sepsis and three patients required blood transfusion. There were no thoracic complications. Conclusions: Upper-pole renal stones can be safely and effectively treated percutaneously using direct upper-pole puncture via an infra-costal approach in supine position, as well as in prone position.