Ultrasound-guided One Supracostal Upper-pose Percutaneous Access For Staghorn Stone

Objective To evalute the safety and efficacy of ultrasound-guided supracostal singleupper-calyx percutaneous access for staghorn stone.Methods A total of581patients with staghorn stone were treated withultrasound-guided supracostal single upper-calyx access percutaneous nephrolithotomyfrom October2004to October2011. The maximal diameter of stone was measured bypre-operation plain abdominal radiography of the kidneys, ureters, and bladders. The meanstone size was5.1centimeters (3.6to6.5centimeters). Target calyx was posteriorupper-calyx，puncture point was selected in tenth or eleventh intercostal space. Then22-24F upper-calyx percutaneous access was established.17F nephroscope and70W(3.5J×20Hz) holmium laser were employed to fragment stone.At the condition that stone canonly be partially seen by nephroscope but unable to fragment,90W(2.0J×45Hz)holmium laser was used to split the calyx mucosa, then crush the stone; flexiblenephroscope combined with70W laser was chose to manage stone if it located in posteriormiddle or lower-calyx. Operative time, perioperative complications, one stage stone-freerate was recorded routinely.Results The upper-calyx percutaneous access was established successfully in allpatients. The stone-free rate was85.4%(496/581) after first-stage procedure.11thintercostal space access was established in546patients, while10thintercostal space waschose in others. The mean operative time was82minutes (54to140minutes). Calyxmucosa was split with laser in49patients (8.4%).14patients (2.4%) had postoperativehigh fever, three of them (0.5%) had infectious shock. Four patients (0.7%) received bloodtransfusion, two of them underwent digital subtraction angiography to control bleeding.Four patients (0.7%) suffered from hydrothorax, three of them were employed10thintercostal space access. All patients with hydrothorax were cured by closed drainage ofthoracic cavity. There was no injury involved lung, spleen, colon, liver, etc. The overallpostoperative complication rate was3.8%. The mean postoperative hospital stay was5.5days (4-15days). One month after PCNL,558patients were examined by CT scan toevalute the stone residue.46patients were diagnosed with stone residue,10of them (1.7%)were treated with ESWL,15(2.6%) were treated with URS for stone residue while21patients were conservative observed.23patients (4.0%) lost to follow-up.Conclusions Treating staghorn stone with supracostal single upper-calyxpercutaneous access is feasible and effective while relative high rate of complication can not be neglected. Ultrasound-guided technique can be a safe supplementary strategy toreduce the risk of complication.