Upper-pole puncture in percutaneous nephrolithotomy: a retrospective review of treatment safety and efficacy

OBJECTIVE To review the safety and efficacy of supracostal puncture during percutaneous nephrolithotomy (PCNL) for renal calculi. PATIENTS AND METHODS Over a 12-year period, 66 patients had either an upper-pole puncture alone or combined with middle- or lower-pole puncture during PCNL for renal calculi. All punctures were made by an experienced uroradiologist and were either supra- or subcostal. We retrospectively reviewed all case notes and radiographs to determine stone-clearance rates and complications associated with the site and number of punctures. RESULTS There was an overall stone-free rate of 78% with upper-pole puncture alone or combined with middle- or lower-pole puncture. There was a 3% thoracic complication rate with upper pole punctures, and an overall complication rate of 30% for both thoracic and non-thoracic complications. CONCLUSION Upper-pole puncture in PCNL is associated with minimum morbidity if done by an experienced urologist or radiologist. The stone-free rate appears to be more dependent on stone size and complexity than the site of puncture.