Supracostal Approach for PCNL: Is 10th and 11th Intercostal Space Safe According to Clavien Classification System?

The purpose of this study was to evaluate the success and morbidity of percutaneous nephrolithotomy (PCNL) performed through the 11th and 10th intercostal space. Between March 2005 and February 2012, 612 patients underwent PCNL, 243 of whom had a supracostal access. The interspace between the 11th and 12th rib was used in 204 cases (group 1) and between the 10th and 11th interspaces in 39 cases (group 2). PCNL was performed using standard supracostal technique in all patients. The operative time, success rate, hospital stay, and complications according to the modified Clavien classification were compared between group 1 and group 2. The stone-free rate was 86.8% in group 1 and 84.6% in group 2 after one session of PCNL. Auxiliary procedures consisting of ureterorenoscopy (URS) and shock wave lithotripsy (SWL) were required in 5 and 7 patients, respectively, in group 1; and in 1 patient each in group 2. After the auxiliary procedures, stone-free rates increased to 92.6% in group 1 and 89.7% in group 2. A total of 74 (30.4%) complications were documented in the 2 groups according to modified Clavien classification. Grade-I complications were recorded in 20 (8.2%), grade-II in 38 (15.6%), grade-IIIa in 13 (5.3%), and grade-IIIb in 2 (0.8%) patients; grade-IVa was recorded in 1 (0.4%) patient. There were no grade-IVb or grade-V complications. Overall complication rate was 30.9% in group 1 and 28.2% in group 2. Supracostal PCNL in selected cases is effective and safe with acceptable complications. The modified Clavien system provides a standardized grading system for complications of PCNL.