الفهرس 
ENDOUROLOGIC ANATOMY OF THE KIDNEYOnly 14 pages are availabe for public view
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Abstract
The evaluation of safety and efficacy of supracostal
percutaneous nephrolithotomy was the aim of our prospective
non randomized study conducted during the period from March
2014 till September 2017 in urology department, Ain shams
and Misr University for science and technology hospitals. The
study included 30 patients comprising 24 males (80%) and 6
females (20%). Their mean age was 33.3 ± 9.1 and the range is
(20 – 52). The mean operative time ranged between 50 minutes
and 120 minutes. We achieved a 94% stone-free rate. The mean
hospital stay was 3.6 days (2-5). 18 procedures (60.0%) were
completed with one puncture and 12 procedures (40.0%) was
completed with two punctures at least one of them was
supracostal. one procedure (3.3%) done with supra 11th rib
(between 11h rib and10th rib) while 29 procedures (96.7%)
through supra 12th rib approach (between12th rib and11th rib).
Supracostal access above 11th rib should be done only by
surgeons with expertise in obtaining the access and when the
benefits outweigh the increased risk of intrathoracic complications.
A chest X ray immediately post operative is mandatory
in all patients treated with this approach for early detection of
any complications.
In conclusion, the supracostal approach was found to be
effective as well as safe, with acceptable complications. The
supracostal approach offers the advantages of a short direct tract with excellent visibility of most of the calyces, high stone
clearance rates with acceptable morbidity rates, reasonable
operative duration, and good stone-free rates. Thus although the
supracostal approach is associated with a small risk of chest
complications, such problems are easily managed by inserting a
chest tube, and can usually be avoided if precautions are
adequate. We believe that if the supracostal approach is indicated,
it should be used with caution. However with the advantage of
flexible nephroscopy and laser, the need of supracostal rigid
nephroscopy will decrease except for large and complex renal
stones. By using a flexible nephroscopy, the surgeon is able to
reach portions of the collecting system that might not have been
reached with a rigid instrument. This allows for careful inspection
of the renal collecting system during PCNL.