Tubeless and stentless percutaneous nephrolithotomy in patients requiring supracostal access.

Objective: To evaluate the feasibility and safety of supracostal access in tubeless and stentless percutaneous nephrolithotomy (PCNL).

Methods: From March 2005 to June 2007, 10 patients underwent tubeless and stentless PCNL via supracostal access. Patients requiring more than 2 percutaneous tracts, or those with significant intraoperative bleeding were excluded from the study. Perioperative and postoperative outcomes for these patients (the study group) were compared with those of a similar number of patients who underwent unilateral PCNL via an intercostal approach with routine placement of a nephrostomy tube before March 2005 (the control group). The 2 groups had a comparable demographic data.

Results: Patients undergoing tubeless and stentless PCNL required less analgesia (p = 0.001) and were discharged earlier (p = 0.000) than were those in the control group. The difference in the mean decrease in hemoglobin concentration was not statistically significant.

Conclusions: Supracostal access in tubeless and stentless PCNL appears to be safe and feasible, offering the advantages of a lower need for analgesia and a shorter hospital stay without increasing thoracic complications.