Comparison of subcostal and supracostal access in percutaneous nephrolithotomy of isolated upper pole stone: A prospective randomized clinical trial.

Purpose: To assess and compare the safety and efficacy of supracostal and subcostal access percutaneous nephrolithotomy (PCNL) for isolated upper pole stones, we designed a prospective randomized clinical trial.

Materials and methods: A prospective randomized study of 76 patients (18-65 years old) was conducted from January 2024 to September 2024 on isolated upper calyceal renal stones at a medical teaching hospital. The eligible participants were divided into subcostal and supracostal access for PCNL groups (38 patients per group). The measured variables included age, sex, body mass index, stone size, comorbidities, procedure time, stone-free rate, hospital stay, and complications (modified Clavien Dindo grading).

Results: Of 76 patients, 47 were male and 29 female, with a mean age of 47 and 53 years for the subcostal and supracostal groups, respectively. The mean stone size was 27.38 and 28.89 mm in the two studied groups, respectively. The mean operation and fluoroscopy time, hospital stay, laboratory data, and complications had no significant difference between the two investigated groups.

Conclusion: Unlike the traditional view, supracostal access during PCNL is safe and effective and is not associated with a higher incidence of postoperative complications. However, both procedures were performed by skilled surgeons, so surgeons should have sufficient training and choose the proper method for each patient individually to minimize complications and obtain the best results. Further studies with a large number of cases are recommended.