IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 7 Ver. III (July 2016), PP 18-25 www.iosrjournals.org DOI: 10.9790/0853-150731825 www.iosrjournals.org 18 | Page The Influence of Access on the Efficacy and Complications in PCNL for Renal Calculi Dr Lokesh Sharma 1 , Dr Nisar Ahmed 2 , Dr Vengetesh Kilvani Sengottayan 3 1,2 Department Of Urology, NIMS Medical College, Jaipur, Rajasthan, India, 303121. 3 GKNM Hospital Coimbatore-641012 Abstract: PCNL has remained standard procedure for renal calculi patients. Over the years, improvements in techniques, instruments and better understanding of anatomy has led diminished complications rate. However significant complications still occurs. Here we tried to determine the effects of percutaneous access point, number and location on success as well as complication rates during PCNL. This was a prospective study of patients who underwent PCNL between august 2012 to November 2013.Total 166 patients were studied. Stone was categorized as simple in 75 (45.2%) and complex in 91 (54.2%). Out of 91 renal units with complex stones, in 56 complete clearance could achieve in first setting. Among the rest 35 renal units, 19 underwent relook PCNL. Out of 75 cases with simple calculi 63 achieved complete clearance in first setting, 12 had residual calculi. It is evident from the study that clearance rates were not dependent on the site and number of access. Keywords: complex calculi., intercostal chest drain, PCNL, supracostal, I. Introduction The first description of percutaneous stone removal was that of Rupel and Brown [1] of Indianapolis, who removed a stone through a previously established surgical nephrostomy track. It was not until 1955, however, that Goodwin described the first placement of a percutaneous nephrostomy tube to drain a grossly hydronephrotic kidney [2], however he did it without imaging. In 1976, Fernstrom and Johannson first reported the establishment of percutaneous access with the specific intention of removing a renal stone. Subsequent advances in endoscopes, imaging equipment, and intracorporeal lithotripters allowed urologists and radiologists to refine these percutaneous techniques through the late 1970s and early 1980s into well-established methods for removal of upper urinary tract calculi. As the percutaneous approach to stone removal is superior to the open approach in terms of morbidity, convalescence, and cost, Percutaneous Nephrolithotomy (PNL) has replaced open surgical removal of large or complex calculi at most institutions Percutaneous nephrolithotomy maintains its position as the most effective treatment option for patients with large stone burdens, in situations associated with complex renal anatomy, and when attempting to achieve an immediate state is a high priority. Improvements in technique and instruments have diminished complication rates associated with this procedure. However, significant complications, such as hemorrhage, encountered in 1 – 23% of cases, intrathoracic complications, observed in 2–12.5%, and other organ injuries, observed in <1%, are being reported with percutaneous renal surgery [3-12]. The necessity for supracostal access, multiple tract procedures, prolonged operation time, occurrence of intraoperative complications and method of percutaneous tract dilation are major outstanding risk factors associated with increased morbidity and complication rates [7, 11]. The literature is replete with studies that have assessed the complications of PCNL. But studies that have documented the effect of site of access, total number of tracts dilated on the clearance of stones and occurrence of complications are very few [2, 13]. Herein, we assess our experience in order to determine the effects of percutaneous access point, number and location on success as well as complication rates during PNL at our Centre. II. Material And Methods This study was conducted in the department of urology, NIMS medical college, Jaipur, between August 2012 to November 2013. All patients undergoing PCNL for renal calculi were included in the study. A written informed consent was taken from the patients before enrolling them for the study. Routine investigations were done, along with IVP, postop stone clearance monitored with x ray. The stone burden was determined by radiographic studies, and stones were basically classified as simple (isolated renal pelvis, or isolated caliceal stones) or complex (partial or complete staghorn stones, renal pelvis stones with caliceal stones), regardless of their size. Anemia was treated pre- operatively; prophylactic antibiotics were given to all patients. PCNL was done as a single stage procedure under general or regional anesthesia. Ureteric catheter was used in all patients to delineate the system. Access usually achieved through bulls eye technique. For a supracostal access, the needle puncture was placed immediately above the upper border of lower rib to avoid damage to the intercostal