Sajad Ahmad PARA, Younis MUSHTAQ, Abdul Rouf KHAWAJA, Firdous Ahmad BEIGH, Tufeel Ahmad KHAN, Gokul KANNAN, Aamir Bashir RAINA
Journal of Urological Surgery - 2026;13(2):121-128
Objective: Percutaneous nephrolithotomy (PCNL) is considered the gold standard for the treatment of kidney stones >2 cm in size and those who fail other treatment modalities. Standard PCNL is associated with a significant number of complications mostly attributed to the larger tract circumference. Mini-PCNL, which utilizes a small tract size of less than 22 Fr, is associated with significantly fewer complications while maintaining a clearance rate comparable to that of standard PCNL. Prone position leads to upward migration of the kidney under the rib cage, making supracostal puncture necessary in a significant number of cases. Mini-PCNL, when performed under spinal anesthesia, is safe and reduces operative time without compromising stone clearance rate. This study was carried out to establish the safety and efficacy of supracostal tubeless mini-PCNL done under spinal anesthesia. Materials and Methods: This is a retrospective study carried over a period of 5 years. It includes all the patients who underwent supracostal mini-PCNL under spinal anesthesia. The procedure was carried out in the prone position, employing 18 Fr Amplatz sheath with 12 Fr nephroscope. The outcome and perioperative complications were recorded and stored via Microsoft Excel and analyzed using SPSS Software, version 20.0. Results: This study included 1135 patients with an average age of 40.6+/-13.8 years. The average stone size was 2.87+/-0.98 cm, and stones had predominantly calyceal distribution in 42.37% of cases. The 11th and 10th intercostal spaces were entered in 89.16% and 10.83% of cases, respectively, to gain access to superior (35.85%) and middle (64.14%) calyces. A single tract was usually required (78.32%) and the average operative time was 52.72+/-11.42 minutes. The rate of blood transfusion was 0.61%, and angioembolization was required to seal pseudoaneurysm/AVF in 0.52% of patients. The rate of hydrothorax/pneumothorax associated with 11th and 10th intercostal space entry was 0.49% and 7.3%, respectively. Only 1.23% of patients required intracostal tube drainage for pneumothorax/hydrothorax. The average rates of stone clearance and hospital stay were 97.53% and 1.8+/-0.45 days, respectively. Conclusion: Supracostal tubeless mini-PCNL done under spinal anesthesia is safe and has high stone clearance rate. The associated thoracic and non-thoracic complications are minimal and the procedure can be safely performed when indicated, provided proper technique is employed.
