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MEASUREMENT OF RENAL INTRAPELVIC PRESSURE DURING MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTOMY (MPCNL), USING PRESSURISED IRRIGATION OF 350MMHG
477 THE ANATOMICAL LANDMARKS AND ANGLES FOR PERCUTANEOUS NEPHROLITHOTOMY Turna B.1, Akbay K.1, Mukhtarov E.1, Celik S.2, Altay B.1, Apaydin E.1, Semerci B.1, Nazli O.1 1 Ege University School of Medicine, Dept. of Urology, Izmir, Turkey, 2Ege University School of Medicine, Dept. of Anatomy, Izmir, Turkey
Introduction & Objectives: The initial manual percutaneous access during percutaneous nephrolithotomy (PCNL), using 2D, is absolutely critical for the successful performance of the surgery. We conducted a prospective study in order to describe the external anatomical landmarks and angles in the prone position for PCNL under x-ray guidance. Material & Methods: %HWZHHQ0D\2FWREHUSDWLHQWVXQGHUJRLQJ3&1/IXOᚏOOHG the study criteria. The inclusion criteria was a patient undergoing PCNL for renal stone(s) preplanned for lower caliceal puncture, the number of access attempts to the target calyx was ืDQGREVHUYDWLRQRIFOHDUXULQHIURPWKHQHHGOH7KHH[FOXVLRQFULWHULDZHUHSUHYLRXVLSVLODWHUDO NLGQH\VXUJHU\VHYHUHK\GURQHSKURVLVUHQDODQRPDO\VNHOHWDOV\VWHPDQRPDO\%0,!NJ m2XSSHUPLGGOHFDOLFHDOSXQFWXUHDQGSDWLHQWVื\HDUV%HIRUHWKHLQLWLDOSXQFWXUHVHYHUDO DQDWRPLFDOOLQHV>SRVWHULRUD[LOODUOLQH 3$/ SRVWHULRUPLGGOHOLQH 30/ DQGWKH[UD\YHUWLFDO SURMHFWLRQRIWKHOLQHWUDYHUVLQJWKHXSSHUHGJHRIWKHLOLDFFUHVW 8,&/ @DQGSRLQWV>WKHWLSRI the twelfth rib (C point) and the x-ray vertical projection of the lower edge of the lower calyx (I point)] are marked by a sterile pen. Then, the urologist punctures the skin (N point) aiming the I point under x-ray guidance using 2D during inspirium. During needle removal, the length (Pi) of the internal portion of the needle inside the patient is measured. The tract is dilated, a standard PCNL procedure performed and a nephrostomy tube placed. Upon completion, several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statistics was performed. Results: All punctures were below the twelfth rib. All procedures were successfully completed ZLWKRXWDQ\LQWUDRSHUDWLYHFRPSOLFDWLRQV7KHPHDQOHQJWKRI3LZDVFP UDQJH D was 11.7 cm (range 5.5-15.5), b was 5.5 cm (range 1.5-11 cm), x was 4.8 cm (range 1-8), x1 ZDVFP UDQJH \ZDVFP UDQJH \ZDVFP UDQJH DQGW ZDVFP UDQJH 7KHPHDQDQJOHRIDZDV| UDQJH| EZDV| UDQJH 20-60º) and g was 56.1º (range 27.5-72º). Conclusions: Knowledge of these anatomical landmarks and angles may help urologists the ability to perform a precise, repetitive and controlled task in accomplishing accurate percutaneous lower caliceal access during PCNL.
478 MEASUREMENT OF RENAL INTRAPELVIC PRESSURE DURING MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTOMY (MPCNL), USING PRESSURISED IRRIGATION OF 350MMHG Tai C.K., Li S.K., Fung T.C., Chau H., Fan C.W., Hou S.M. Pamela Youde Nethersole Eastern Hospital, Dept. of Surgery, Division of Urology, Hong Kong, China Introduction & Objectives: 5HQDOLQWUDSHOYLFSUHVVXUHJUHDWHUWKDQPP+J (40.8cmH2O) has been shown to be associated with pyelovenous-lymphatic EDFNᚐRZ ZKLFK PD\ EH WKH URXWH IRU V\VWHPLF DEVRUSWLRQ RI LUULJDWLRQ ᚐXLG containing bacteria or endotoxin. As MPCNL according to Chinese method, XVHV KLJK SUHVVXUH LUULJDWLRQ XS WR PP+J WKURXJK WKH HQGRVFRSH DQG UHWURJUDGH ᚐXVKLQJ WR IDFLOLWDWH VWRQH UHPRYDO ZH VWXG\ ZKHWKHU WKH UHQDO intrapelvic pressure would be dangerously elevated in this procedure. Material & Methods: An 8 Fr pigtail catheter was placed in the renal pelvis and connected to a central venous pressure measuring set for pressure UHFRUGLQJ 5HDGLQJ ZDV WDNHQ GXULQJ GLᚎHUHQW PDQLSXODWLRQV HQGRVFRSH LQ GLᚎHUHQW SRVLWLRQV RI SHOYLFDO\FHDO V\VWHPV LQ XUHWHU LQ ZRUNLQJ VKHDWK DQG GXULQJ IRUFHIXO ᚐXVKLQJ YLD XUHWHULF FDWKHWHU 7RZDUGV WKH HQG RI RSHUDWLRQ while withdrawing the working sheath with the endoscope in situ, pressure measurement was taken for simulation of sheath dislodgement. Results: 5 patients undergoing MPCNL were enrolled. Pressure readings taken during the procedures were all below the threshold value (mean 11.7 cmH2O, range 5.5 to 18cmH2O). Sustained elevated pressure was only observed during simulation of sheath dislodgement (mean 47cm H2O, range WR FP+2 )RUFHIXO ᚐXVKLQJ YLD XUHWHULF FDWKHWHU RQO\ JDYH ULVH WR WUDQVLHQWVXUJHRILQWUDSHOYLFSUHVVXUHFORVHWRWKHWKUHVKROG PHDQFP+2 UDQJHIURPFP+2 Conclusions: MPCNL, according to the Chinese method, even with SUHVVXUL]HGLUULJDWLRQRIPP+JLVQRWDVVRFLDWHGZLWKVLJQLᚏFDQWHOHYDWLRQ of the renal intrapelvic pressure. Dislodgement of sheath leads to sustained elevated intrapelvic pressure exceeding safety level and should be avoided.
479
480
TUBELESS VERSUS CONVENTIONAL PERCUTANEOUS NEPHROLITHOTOMY (PNL): A PROSPECTIVE RANDOMISED TRIAL
TUBELESS PERCUTANEOUS NEPHROLITHOTOMY (PCNL): 3 YEARS EXPERIENCE WITH 454 PATIENTS
Shoma M., Elshal A.
Shah H., Khandkar A., Kharodawala S., Sodha H., Hegde S., Bansal M.
Urology and Nephrology centre, Dept. of Urology, Mansoura, Egypt
R.G. Stone Urological Research Institute, Dept. of Urology, Mumbai, India
Introduction & Objectives: Traditionally, a tube nephrostomy drainage is recommended after PNL. Nevertheless, the tube has been implicated in causing postoperative discomfort and morbidity. Therefore, routine placement of nephrostomy tube after an uncomplicated PNL has been questioned. In this study we compared in a prospective randomized fashion the standard PNL with and without nephrostomy tube. To our knowledge no study has been reported in the literature comparing these procedures in a prospective randomized manner.
Introduction & Objectives: Although Bellman reported on safety of tubeless PCNL 10 years back, it is still not widely accepted in urological community. We present our experience with SDWLHQWVZKRXQGHUZHQWWXEHOHVV3&1/RYHUODVW\HDUV7RWKHEHVWRIRXUNQRZOHGJH this represents largest single centre experience of tubeless PCNL.
Material & Methods: Between February and October 2007, 50 patients with renal calculi undergoing PNL were randomized to receive no nephrostomy drainage (group I, 25 patients) or standard nephrostomy drainage (group II, 25 patients). Exclusion criteria were bleeding tendency and pancalyceal stones and/or stones associated with other pathology requiring open intervention. Randomization was performed by closed envelops just before the procedure. All cases were done by one surgeon. The pre & postoperative hemoglobin (Hb) were measured and compared. The stones size and location were evaluated preoperatively by intravenous urography and/or non contrast spiral CT (NCCT). Postoperatively, NCCT was repeated to evaluate the stone free rate and detected perinephric hematoma. Postoperative pain was assessed by visual analogue pain scale system and the need for postoperative analgesia was recorded. The hospital stay was compared. Results: ,QJURXS,WKHPHDQVWRQHEXONZDVPP2, 8 cases had staghorn stones and ZHUH UHFXUUHQW ,Q WKH JURXS ,, WKH PHDQ VWRQH EXON LV PP2, 6 cases had staghorn VWRQHVDQGZHUHUHFXUUHQW6XFFHVVIXOUHPRYDORIWKHWDUJHWVWRQHVFRXOGEHDFKLHYHGLQ 25 and 24 cases of group I& II respectively (P= 0.6). The stones could be retrieved in one VHVVLRQLQDOOEXWZKRUHTXLUHGVHFRQGORRN RIJURXS,DQG,,UHVSHFWLYHO\ 1RQWDUJHW UHVLGXDO FDOFXOL ZHUH UHFRUGHG LQ FDVHV RI JURXS , ,, DQG ZHUH PDQDJHG E\ (6:/ Postoperative urine leakage through percutaneous tract is noticed in 20 cases of group II and stopped spontaneously after 6-72 hours. There was no leakage in group I. The average drop LQWKH+EOHYHOZDV JPLQJURXS,DQG,, 3 6LJQLᚏFDQWSHULQHSKULFKHPDWRPD was noticed in 1 and2 cases of group I and II respectively. Abdominal exploration was done in the patient with tubeless PCNL while the others were managed with bed rest and blood WUDQVIXVLRQ 3RVWRSHUDWLYH SDLQ VFRUH DQG DQDOJHVLD FRQVXPSWLRQ ZHUH VLJQLᚏFDQWO\ OHVV LQ WXEHOHVV3&1/ 3 0HDQKRVSLWDOVVWD\ZDVDQGGD\VLQJURXS,DQG,, UHVSHFWLYHO\ 3 Conclusions: Tubeless PNL is associated with less pain, urinary leakage and hospital stay. Nephrostomy drainage may be reserved for the procedures with documented intraoperative residual stones where the need for second look is of paramount importance.
Eur Urol Suppl 2008;7(3):190
Material & Methods: From September 2004 onwards all patients with large renal and/or upper ureteric calculi were planned to undergo tubeless PCNL at our institute. Patients with VROLWDU\NLGQH\ VHUXPFUHDWLQLQH!PJ SULRULSVLODWHUDORSHQUHQDOVXUJHU\ DVVRFLDWHGFDO\FHDOGLYHUWLFXOXP 38-REVWUXFWLRQ XQGHUJRLQJELODWHUDOV\QFKURQRXV 3&1/ DQG QHHGLQJ VXSUDFRVWDO DFFHVV ZHUH DOVR HQUROOHG LQ WKH VWXG\ 7KH H[FOXVLRQ FULWHULD IRU VWXG\ ZHUH SDWLHQWV QHHGLQJ ! SHUFXWDQHRXV DFFHVV SUHVHQFH RI VLJQLᚏFDQWEOHHGLQJRUUHVLGXDOVWRQHEXUGHQQHFHVVLWDWLQJVWDJHGSURFHGXUH$OOSDWLHQWVKDG ureteric stent placed in an antegrade manner. Patients demographics data and peri-operative outcome was analysed. Results: )URP6HSWHPEHUWR$XJXVWUHQDOXQLWVLQSDWLHQWVXQGHUZHQW WXEHOHVV 3&1/ 2I SDWLHQWV XQGHUJRLQJ ELODWHUDO V\QFKURQRXV 3&1/ SURFHGXUH ZDV WXEHOHVV ELODWHUDOO\ LQ SDWLHQWV DQG XQLODWHUDOO\ LQ UHPDLQLQJ 7ZR DQG WUDFWV ZHUH UHTXLUHGLQDQGSDWLHQWVUHVSHFWLYHO\2IWRWDOUHQDOWUDFWVZHUHWKURXJKth intercostal space and 81 were through 10th intercostal space. The mean stone size was 2.2 FPDQGGXUDWLRQRIVXUJHU\ZDVPLQXWHV7KHPHDQDQDOJHVLDQHHGHGZDVPJ of diclofenac sodium or its equivalent. The mean duration of catheterization and hospital stay ZHUH DQG KRXUV UHVSHFWLYHO\ 7KH PHDQ GURS LQ KHPRJORELQ ZDV J DQG 19 patients (4.18%) needed blood transfusion. There was no incidence of urinary leakage or urinoma. After supracostal access, 15 (4.8%) had hydrothorax. All these patients were WUHDWHGFRQVHUYDWLYHO\H[FHSW ZKRUHTXLUHGLQWHUFRVWDOGUDLQDJH&RPSOHWHVWRQH FOHDUDQFHZDVDFKLHYHGLQ UHQDOXQLWVDQGUHQDOXQLWVKDGUHVLGXDOIUDJPHQWV PP6HFRQGSURFHGXUHZDVQHHGHGLQUHQDOXQLWV2ISDWLHQWVZKRZHUHJLYHQ VWHQWV\PSWRPTXHVWLRQQDLUHKDGERWKHUVRPHVWHQWUHODWHGV\PSWRPV Conclusions: 7XEHOHVV3&1/LVVDIHDQGHᚎHFWLYHSURFHGXUHHYHQLQSDWLHQWVZLWKVROLWDU\ NLGQH\SDVWLSVLODWHUDORSHQVXUJHU\UDLVHGVHUXPFUHDWLQLQHLQSUHVHQFHRIUHQDODFFHVVHV and in patients undergoing bilateral synchronous PCNL. It has potential advantages of decreased analgesic requirement and hospital stay without increasing morbidity. Further VWXGLHV DUH QHHGHG WR VHH LI DQ\ PRGLᚏFDWLRQ RI XUHWHULF VWHQW RU LWV DYRLGDQFH FDQ VDIHO\ decrease or avoid stent related morbidity in this patients.
Introduction & Objectives: The initial manual percutaneous access during percutaneous nephrolithotomy (PCNL), using 2D, is absolutely critical for the successful performance of the surgery. We conducted a prospective study in order to describe the external anatomical landmarks and angles in the prone position for PCNL under x-ray guidance. Material & Methods: %HWZHHQ0D\2FWREHUSDWLHQWVXQGHUJRLQJ3&1/IXOᚏOOHG the study criteria. The inclusion criteria was a patient undergoing PCNL for renal stone(s) preplanned for lower caliceal puncture, the number of access attempts to the target calyx was ืDQGREVHUYDWLRQRIFOHDUXULQHIURPWKHQHHGOH7KHH[FOXVLRQFULWHULDZHUHSUHYLRXVLSVLODWHUDO NLGQH\VXUJHU\VHYHUHK\GURQHSKURVLVUHQDODQRPDO\VNHOHWDOV\VWHPDQRPDO\%0,!NJ m2XSSHUPLGGOHFDOLFHDOSXQFWXUHDQGSDWLHQWVื\HDUV%HIRUHWKHLQLWLDOSXQFWXUHVHYHUDO DQDWRPLFDOOLQHV>SRVWHULRUD[LOODUOLQH 3$/ SRVWHULRUPLGGOHOLQH 30/ DQGWKH[UD\YHUWLFDO SURMHFWLRQRIWKHOLQHWUDYHUVLQJWKHXSSHUHGJHRIWKHLOLDFFUHVW 8,&/ @DQGSRLQWV>WKHWLSRI the twelfth rib (C point) and the x-ray vertical projection of the lower edge of the lower calyx (I point)] are marked by a sterile pen. Then, the urologist punctures the skin (N point) aiming the I point under x-ray guidance using 2D during inspirium. During needle removal, the length (Pi) of the internal portion of the needle inside the patient is measured. The tract is dilated, a standard PCNL procedure performed and a nephrostomy tube placed. Upon completion, several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statistics was performed. Results: All punctures were below the twelfth rib. All procedures were successfully completed ZLWKRXWDQ\LQWUDRSHUDWLYHFRPSOLFDWLRQV7KHPHDQOHQJWKRI3LZDVFP UDQJH D was 11.7 cm (range 5.5-15.5), b was 5.5 cm (range 1.5-11 cm), x was 4.8 cm (range 1-8), x1 ZDVFP UDQJH \ZDVFP UDQJH \ZDVFP UDQJH DQGW ZDVFP UDQJH 7KHPHDQDQJOHRIDZDV| UDQJH| EZDV| UDQJH 20-60º) and g was 56.1º (range 27.5-72º). Conclusions: Knowledge of these anatomical landmarks and angles may help urologists the ability to perform a precise, repetitive and controlled task in accomplishing accurate percutaneous lower caliceal access during PCNL.
478 MEASUREMENT OF RENAL INTRAPELVIC PRESSURE DURING MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTOMY (MPCNL), USING PRESSURISED IRRIGATION OF 350MMHG Tai C.K., Li S.K., Fung T.C., Chau H., Fan C.W., Hou S.M. Pamela Youde Nethersole Eastern Hospital, Dept. of Surgery, Division of Urology, Hong Kong, China Introduction & Objectives: 5HQDOLQWUDSHOYLFSUHVVXUHJUHDWHUWKDQPP+J (40.8cmH2O) has been shown to be associated with pyelovenous-lymphatic EDFNᚐRZ ZKLFK PD\ EH WKH URXWH IRU V\VWHPLF DEVRUSWLRQ RI LUULJDWLRQ ᚐXLG containing bacteria or endotoxin. As MPCNL according to Chinese method, XVHV KLJK SUHVVXUH LUULJDWLRQ XS WR PP+J WKURXJK WKH HQGRVFRSH DQG UHWURJUDGH ᚐXVKLQJ WR IDFLOLWDWH VWRQH UHPRYDO ZH VWXG\ ZKHWKHU WKH UHQDO intrapelvic pressure would be dangerously elevated in this procedure. Material & Methods: An 8 Fr pigtail catheter was placed in the renal pelvis and connected to a central venous pressure measuring set for pressure UHFRUGLQJ 5HDGLQJ ZDV WDNHQ GXULQJ GLᚎHUHQW PDQLSXODWLRQV HQGRVFRSH LQ GLᚎHUHQW SRVLWLRQV RI SHOYLFDO\FHDO V\VWHPV LQ XUHWHU LQ ZRUNLQJ VKHDWK DQG GXULQJ IRUFHIXO ᚐXVKLQJ YLD XUHWHULF FDWKHWHU 7RZDUGV WKH HQG RI RSHUDWLRQ while withdrawing the working sheath with the endoscope in situ, pressure measurement was taken for simulation of sheath dislodgement. Results: 5 patients undergoing MPCNL were enrolled. Pressure readings taken during the procedures were all below the threshold value (mean 11.7 cmH2O, range 5.5 to 18cmH2O). Sustained elevated pressure was only observed during simulation of sheath dislodgement (mean 47cm H2O, range WR FP+2 )RUFHIXO ᚐXVKLQJ YLD XUHWHULF FDWKHWHU RQO\ JDYH ULVH WR WUDQVLHQWVXUJHRILQWUDSHOYLFSUHVVXUHFORVHWRWKHWKUHVKROG PHDQFP+2 UDQJHIURPFP+2 Conclusions: MPCNL, according to the Chinese method, even with SUHVVXUL]HGLUULJDWLRQRIPP+JLVQRWDVVRFLDWHGZLWKVLJQLᚏFDQWHOHYDWLRQ of the renal intrapelvic pressure. Dislodgement of sheath leads to sustained elevated intrapelvic pressure exceeding safety level and should be avoided.
479
480
TUBELESS VERSUS CONVENTIONAL PERCUTANEOUS NEPHROLITHOTOMY (PNL): A PROSPECTIVE RANDOMISED TRIAL
TUBELESS PERCUTANEOUS NEPHROLITHOTOMY (PCNL): 3 YEARS EXPERIENCE WITH 454 PATIENTS
Shoma M., Elshal A.
Shah H., Khandkar A., Kharodawala S., Sodha H., Hegde S., Bansal M.
Urology and Nephrology centre, Dept. of Urology, Mansoura, Egypt
R.G. Stone Urological Research Institute, Dept. of Urology, Mumbai, India
Introduction & Objectives: Traditionally, a tube nephrostomy drainage is recommended after PNL. Nevertheless, the tube has been implicated in causing postoperative discomfort and morbidity. Therefore, routine placement of nephrostomy tube after an uncomplicated PNL has been questioned. In this study we compared in a prospective randomized fashion the standard PNL with and without nephrostomy tube. To our knowledge no study has been reported in the literature comparing these procedures in a prospective randomized manner.
Introduction & Objectives: Although Bellman reported on safety of tubeless PCNL 10 years back, it is still not widely accepted in urological community. We present our experience with SDWLHQWVZKRXQGHUZHQWWXEHOHVV3&1/RYHUODVW\HDUV7RWKHEHVWRIRXUNQRZOHGJH this represents largest single centre experience of tubeless PCNL.
Material & Methods: Between February and October 2007, 50 patients with renal calculi undergoing PNL were randomized to receive no nephrostomy drainage (group I, 25 patients) or standard nephrostomy drainage (group II, 25 patients). Exclusion criteria were bleeding tendency and pancalyceal stones and/or stones associated with other pathology requiring open intervention. Randomization was performed by closed envelops just before the procedure. All cases were done by one surgeon. The pre & postoperative hemoglobin (Hb) were measured and compared. The stones size and location were evaluated preoperatively by intravenous urography and/or non contrast spiral CT (NCCT). Postoperatively, NCCT was repeated to evaluate the stone free rate and detected perinephric hematoma. Postoperative pain was assessed by visual analogue pain scale system and the need for postoperative analgesia was recorded. The hospital stay was compared. Results: ,QJURXS,WKHPHDQVWRQHEXONZDVPP2, 8 cases had staghorn stones and ZHUH UHFXUUHQW ,Q WKH JURXS ,, WKH PHDQ VWRQH EXON LV PP2, 6 cases had staghorn VWRQHVDQGZHUHUHFXUUHQW6XFFHVVIXOUHPRYDORIWKHWDUJHWVWRQHVFRXOGEHDFKLHYHGLQ 25 and 24 cases of group I& II respectively (P= 0.6). The stones could be retrieved in one VHVVLRQLQDOOEXWZKRUHTXLUHGVHFRQGORRN RIJURXS,DQG,,UHVSHFWLYHO\ 1RQWDUJHW UHVLGXDO FDOFXOL ZHUH UHFRUGHG LQ FDVHV RI JURXS , ,, DQG ZHUH PDQDJHG E\ (6:/ Postoperative urine leakage through percutaneous tract is noticed in 20 cases of group II and stopped spontaneously after 6-72 hours. There was no leakage in group I. The average drop LQWKH+EOHYHOZDV JPLQJURXS,DQG,, 3 6LJQLᚏFDQWSHULQHSKULFKHPDWRPD was noticed in 1 and2 cases of group I and II respectively. Abdominal exploration was done in the patient with tubeless PCNL while the others were managed with bed rest and blood WUDQVIXVLRQ 3RVWRSHUDWLYH SDLQ VFRUH DQG DQDOJHVLD FRQVXPSWLRQ ZHUH VLJQLᚏFDQWO\ OHVV LQ WXEHOHVV3&1/ 3 0HDQKRVSLWDOVVWD\ZDVDQGGD\VLQJURXS,DQG,, UHVSHFWLYHO\ 3 Conclusions: Tubeless PNL is associated with less pain, urinary leakage and hospital stay. Nephrostomy drainage may be reserved for the procedures with documented intraoperative residual stones where the need for second look is of paramount importance.
Eur Urol Suppl 2008;7(3):190
Material & Methods: From September 2004 onwards all patients with large renal and/or upper ureteric calculi were planned to undergo tubeless PCNL at our institute. Patients with VROLWDU\NLGQH\ VHUXPFUHDWLQLQH!PJ SULRULSVLODWHUDORSHQUHQDOVXUJHU\ DVVRFLDWHGFDO\FHDOGLYHUWLFXOXP 38-REVWUXFWLRQ XQGHUJRLQJELODWHUDOV\QFKURQRXV 3&1/ DQG QHHGLQJ VXSUDFRVWDO DFFHVV ZHUH DOVR HQUROOHG LQ WKH VWXG\ 7KH H[FOXVLRQ FULWHULD IRU VWXG\ ZHUH SDWLHQWV QHHGLQJ ! SHUFXWDQHRXV DFFHVV SUHVHQFH RI VLJQLᚏFDQWEOHHGLQJRUUHVLGXDOVWRQHEXUGHQQHFHVVLWDWLQJVWDJHGSURFHGXUH$OOSDWLHQWVKDG ureteric stent placed in an antegrade manner. Patients demographics data and peri-operative outcome was analysed. Results: )URP6HSWHPEHUWR$XJXVWUHQDOXQLWVLQSDWLHQWVXQGHUZHQW WXEHOHVV 3&1/ 2I SDWLHQWV XQGHUJRLQJ ELODWHUDO V\QFKURQRXV 3&1/ SURFHGXUH ZDV WXEHOHVV ELODWHUDOO\ LQ SDWLHQWV DQG XQLODWHUDOO\ LQ UHPDLQLQJ 7ZR DQG WUDFWV ZHUH UHTXLUHGLQDQGSDWLHQWVUHVSHFWLYHO\2IWRWDOUHQDOWUDFWVZHUHWKURXJKth intercostal space and 81 were through 10th intercostal space. The mean stone size was 2.2 FPDQGGXUDWLRQRIVXUJHU\ZDVPLQXWHV7KHPHDQDQDOJHVLDQHHGHGZDVPJ of diclofenac sodium or its equivalent. The mean duration of catheterization and hospital stay ZHUH DQG KRXUV UHVSHFWLYHO\ 7KH PHDQ GURS LQ KHPRJORELQ ZDV J DQG 19 patients (4.18%) needed blood transfusion. There was no incidence of urinary leakage or urinoma. After supracostal access, 15 (4.8%) had hydrothorax. All these patients were WUHDWHGFRQVHUYDWLYHO\H[FHSW ZKRUHTXLUHGLQWHUFRVWDOGUDLQDJH&RPSOHWHVWRQH FOHDUDQFHZDVDFKLHYHGLQ UHQDOXQLWVDQGUHQDOXQLWVKDGUHVLGXDOIUDJPHQWV PP6HFRQGSURFHGXUHZDVQHHGHGLQUHQDOXQLWV2ISDWLHQWVZKRZHUHJLYHQ VWHQWV\PSWRPTXHVWLRQQDLUHKDGERWKHUVRPHVWHQWUHODWHGV\PSWRPV Conclusions: 7XEHOHVV3&1/LVVDIHDQGHᚎHFWLYHSURFHGXUHHYHQLQSDWLHQWVZLWKVROLWDU\ NLGQH\SDVWLSVLODWHUDORSHQVXUJHU\UDLVHGVHUXPFUHDWLQLQHLQSUHVHQFHRIUHQDODFFHVVHV and in patients undergoing bilateral synchronous PCNL. It has potential advantages of decreased analgesic requirement and hospital stay without increasing morbidity. Further VWXGLHV DUH QHHGHG WR VHH LI DQ\ PRGLᚏFDWLRQ RI XUHWHULF VWHQW RU LWV DYRLGDQFH FDQ VDIHO\ decrease or avoid stent related morbidity in this patients.