Comparison of Efficacy of Percutaneous Nephrolithotomy between Supracostal and Subcostal Access in Patients with Renal Stone

Abstract

Background: Percutaneous Nephrolithotomy (PCNL) is a prevalent surgical procedure for the treatment of large renal stones. The choice between supra-costal and sub-costal access is pivotal in optimizing patient outcomes. This study provides an in-depth comparison of these two approaches, contributing to the evolving discourse in urological surgery. Objective: To compare the efficacy and safety of supra-costal and sub-costal access in PCNL for the treatment of renal stones. Methods: A randomized controlled trial was conducted at the Department of Urology, Pakistan Institute of Medical Sciences, from May to October 2023. Sixty-four patients with renal stones larger than 2cm were enrolled and divided into two groups based on the access point: supra-costal (Group A) and sub-costal (Group B). Variables such as age, gender, duration of surgery, stone size, clearance rate, and complications were analyzed using Statistical Package for the Social Sciences (SPSS) Version 25. Results: The average age of participants was 37.20 ± 13.0 years, with surgery duration averaging 45.75 ± 4.98 minutes. The majority of participants were male (59.4%). Stone clearance rates were high in both groups (93.8% in Group A and 90.6% in Group B), with no statistically significant difference (P-value > 0.05). Complication rates were 9.4% in Group A and 15.6% in Group B, also showing no significant difference. Conclusion: Both supra-costal and sub-costal accesses in PCNL are effective for renal stone clearance, with comparable success rates and complication profiles. The choice between these approaches can be based on individual patient anatomy and surgeon preference. Further research could explore long-term outcomes and patient-specific factors influencing the choice of access point.