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SAFETY AND EFFICACY OF SUPRA-COSTAL APPROACH
FOR PCNL IN PEDIATRIC PATIENTS: APPLICATION
OF CLAVIEN CLASSIFICATION SYSTEM
M S ANSARI
1
, Rahul SONI
2
, Aadil FAROOQ
3
and Aneesh SRIVASTAVA
4
1) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediaric urology. Department of Urology and renal
transplantation, Lucknow, INDIA - 2) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology,
Sanajay Gandhi postgraduate institute of Medical Sciences, Lucknow, INDIA - 3) Sanjay Gandhi Postgraduate Institute
of Medical Sciences, Pediatric Urology, Department of Urology and Renal Transplantation, Lucknow, INDIA - 4) Sanjay
Gandhi Postgraduate Institute of Medical Sciences, Pedairic Urology, Department of Urology and Renal Transplantation,
Lucknow, INDIA
PURPOSE
Supracostal access in pediatric patients continues to be underutilized due to an unfounded fear of
thoracic and vascular complications. The purpose of this study was to evaluate the success and
morbidity of percutaneous nephrolithotomy (PCNL) performed through the 11
th
intercostal space
and compare it with the subcostal approach.
MATERIAL AND METHODS
Data of patients with renal calculi under 18 years of age were prospectively collected between
January 2005 and December 2015. Patients were divided into two groups those done with su-
pracostal (group 1) and subcostal access (group 2). Patient characteristics, stone location, stone
burden, number and location of the access point, operative time, visual pain score, success rate,
hospital stay, and complications according to the modified Clavien classification (MCS) were com-
pared between group 1 and group 2.
RESULTS
During the study period 75 paediatric patients underwent PCNL of whom 55 matched the selection
criteria. Of these, 25 and 30 had a supracostal and subcostal access respectively. The stone-free
rate was 84.8% and 85.36% in groups 1 and 2 respectively after one session of PCNL. After the
auxiliary procedures, stone-free rate increased to 96.0% and 97.6% in groups 1 and 2 respectively
(p=0.982). Change in hematocrit level (p=0.261), visual pain score/ need of analgesia (p=0.368)),
and hospital stay (p=0.231) were not statistically different in two groups.
A total of 27 (49%) complications were documented in the two groups according to MCS. Overall
complication rate was 28% in group 1 and 25% in group 2 (p value =0.799). Grade-I complications
were recorded in 17 (30.1%), grade-II in 8 (14.5%) and grade IIIb in 2 (3.63%) patients. Grade-IIIb
complications were recorded in group1 only. There were no grade-IV or grade-V complications.
CONCLUSIONS
Supracostal PCNL in selected cases is effective and safe with acceptable complications. The modi-
fied Clavien system provides a standardized grading system for complications of PCNL in pediatric
patients.