Safety of Supracostal Percutaneous Nephrolithotomy in Paediatric Population: A Single Centre Experience

  • Muhammad Kamran Khan institute of kidney diseases peshawar
  • Naqib Ullah Rehman medical institute
  • Nazim Mohayuddin urology department rehman medical institute peshawar
  • Naveed Haroon
  • Ahmad Nawaz department of urology institute of kidney diseases peshawar
Keywords: Supracostal, Percutaneous Nephrolithotomy, Hydrothorax, Bleeding.



The objective of this study is assessment of safety and efficacy of supracostal mini percutaneous nephrolithotomy in pediatric patients.


This is prospective study of patients whose kidney stones were treated with mini percutaneous nephrolithotomy through supracostal approach between February 2019 and Dec 2020.These patients were selected for supracostal puncture based on preoperative ultrasound and CT KUB findings and peroperative assessment of stone burden, stone location and anatomy of pelvicalyceal system.


Of 80 patients 72(90%) were treated with only one supracostal puncture while additional 2nd puncture was used for 8(10%) patients. Overall stone clearance is 85% only with percutaneous nephrolithotomy and the stone clearance has reached to 95% with ancillary procedures.13% of patient had hydrothorax , 3.75% had urosepsis, 2.75% had bleeding and 1.25 % had perinephric fluid collection.


This study concludes that the safety and efficacy of supracostal percutaneous nephrolithotomy is same as subcostal pcnl if surgical boundaries are not violated.

Author Biographies

Muhammad Kamran Khan, institute of kidney diseases peshawar

asstant professor department of pediatric urology

Nazim Mohayuddin, urology department rehman medical institute peshawar

assistant professor department rehman medical institute peshawar

Naveed Haroon

assistant professor pediatric urology lady reading hospital peshawar

Ahmad Nawaz, department of urology institute of kidney diseases peshawar

assistant professor department of urology institute of kidney diseases peshawar


1. Kittanamongkolchai W, Vaughan LE, Enders FT, Dhondup T, Mehta RA, Krambeck AE, McCollough CH, Vrtiska TJ, Lieske JC, Rule AD. The changing incidence and presentation of urinary stones over 3 decades. InMayo Clinic Proceedings 2018 Mar 1 (Vol. 93, No. 3, pp. 291-299). Elsevier.
2. Yan, M.Y., Lin, J., Chiang, H.C., Chen, Y.L. and Chen, P.H., 2018. Supra-costal tubeless percutaneous nephrolithotomy is not associated with increased complication rate: a prospective study of safety and efficacy of supra-costal versus sub-costal access. BMC urology, 18(1), pp.1-7.
3 Rafi S, Haider A, Wasty WH, Hussain A. Safety and efficacy of supracostal access in percutaneous nephrolithotomy: our experience. Pak J Surg. 2017;33(4):292-5.
4 Knoll T, Daels F, Desai J, Hoznek A, Knudsen B, Montanari E, Scoffone C, Skolarikos A, Tozawa K. Percutaneous nephrolithotomy: technique. World journal of urology. 2017 Sep;35(9):1361-8.
5 Verma A, Tomar V, Yadav S. Complex multiple renal calculi: stone distribution, pelvicalyceal anatomy and site of puncture as predictors of PCNL outcome. Springerplus. 2016 Dec;5(1):1-6.
6 Kekre NS, Gopalakrishnan GG, Gupta GG, Abraham BN, Sharma E. Supracostal approach in percutaneous nephrolithotomy: experience with 102 cases. Journal of endourology. 2001 Oct 1;15(8):789-91.
7 Marchini GS, Berto FC, Vicentini FC, Shan CJ, Srougi M, Mazzucchi E. Preoperative planning with noncontrast computed tomography in the prone and supine position for percutaneous nephrolithotomy: a practical overview. Journal of endourology. 2015 Jan 1;29(1):6-12.
8. Comparison of Supracostal and Infracostal Access For Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. Urology journal. 2019 May 5;16(2):107-14.
9 Jagadeeshwar T, Jahagirdhar R, Bhagawan A, Murthy NR, Ravichandar G, Mallikarjun G, Santosh B, Narendra KV. Safety and efficacy of paediatric PCNL.Journal of Evolution of Medical and Dental Sciences. 2014 Oct 20;3(54):12411-8.
10. Shafi H, Moazzami B, Pourghasem M, Kasaeian A. An overview of treatment options for urinary stones. Caspian journal of internal medicine. 2016;7(1):1.
11 Patel SR, Nakada SY. The modern history and evolution of percutaneous nephrolithotomy.Journal of endourology. 2015 Feb 1;29(2):153-7.
12. Factors that predict safety, success and stone free rate in stag horn and non-stag horn stones: A single centre experience and review of literature. Journal of clinical and diagnostic research: JCDR. 2016 Sep;10(9):PC17.
13 Ravichandar G, Jagadeeshwar T, Bhagavan A, Narendra KV. PCNL-evaluation of supra costal punctures.Journal of Evolution of Medical and Dental Sciences. 2015 Jun 18;4(49):8532-45.
14 Sourial MW, Francois N, Box GN, Knudsen BE. Supracostal access tubeless percutaneous nephrolithotomy: minimizing complications. World journal of urology. 2019 Jul;37(7):1429-33.
15. Mousavi-Bahar SH, Mehrabi S, Moslemi MK. The safety and efficacy of PCNL with supracostal approach in the treatment of renal stones. International urology and nephrology. 2011 Dec;43(4):983-7.
16. Olvera-Posada D, Ali SN, Dion M, Alenezi H, Denstedt JD, Razvi H. Natural history of residual fragments after percutaneous nephrolithotomy: evaluation of factors related to clinical events and intervention. Urology. 2016 Nov 1;97:46-50.
17. Harraz AM, Osman Y, El-Nahas AR, Elsawy AA, Fakhreldin I, Mahmoud O, El-Assmy A, Shokeir AA. Residual stones after percutaneous nephrolithotomy: comparison of intraoperative assessment and postoperative non-contrast computerized tomography. World journal of urology. 2017 Aug;35(8):1241-6.
18 Skolarikos A, Papatsoris AG. Diagnosis and management of postpercutaneous nephrolithotomy residual stone fragments.Journal of endourology. 2009 Oct 1;23(10):1751-5.
19.Bell JR, Nakada SY. Diagnosis and Management of Thoracic Complications of Percutaneous Renal Surgery. Smith's Textbook of Endourology. 2019 Jan 8:409-21.
20Alyami F, Norman RW. Is an overnight stay after percutaneous nephrolithotomy safe? Arab J Urol. 2012 Dec;10(4):367-71. doi: 10.1016/j.aju.2012.07.006. Epub 2012 Aug 29. PMID: 26558051; PMCID: PMC4442911.
21 El-Karamany T. A supracostal approach for percutaneous nephrolithotomy of staghorn calculi: A prospective study and review of previous reports. Arab journal of urology. 2012 Dec 1;10(4):358-66
How to Cite
Khan M, Ullah N, Mohayuddin N, Haroon N, Nawaz A. Safety of Supracostal Percutaneous Nephrolithotomy in Paediatric Population: A Single Centre Experience. JRMC [Internet]. 31Mar.2022 [cited 27May2022];26(1):34-7. Available from: