Efficacy and safety of percutaneous nephrolithotomy using the Triangular technique, accessing the upper pole of the kidney through a subcostal incision for urinary tract stone removal
Keywords:
percutaneous nephrolithotomy, PCNL, kidney stones, percutaneous nephsubcostal access with Triangular technique, pleural injuryAbstract
This study aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) using the triangular technique with upper pole renal access through a subcostal incision.
Methods: A retrospective cohort study was conducted on patients diagnosed with kidney stones who underwent treatment at Nakornping Hospital between January 28, 2020, and December 12, 2023. The study focused on patients who underwent percutaneous nephrolithotomy (PCNL) using the Triangular technique, in which access was gained through the upper pole of the kidney via an incision below the costal margin. Data were collected on stone-free rates, pleural injury, postoperative blood transfusion, postoperative fever, length of hospital stay, and operative time. Descriptive statistics were used for data analysis, and stone-free rates were compared using logistic regression.
Results: A total of 106 patients met the inclusion criteria, of whom 69 (65.1%) were male. The mean age was 55.83 ± 11.76 years, with an average body mass index (BMI) of 24.48 ± 3.88 kg/m². The mean stone surface area was 905.16 ± 553.17 mm². The average operative time for PCNL was 51.31 ± 4.44 minutes, and the mean length of hospital stay was 6.05 ± 1.93 days. The stone-free rate, defined as complete stone clearance or residual fragments ≤4 mm, was 73%. Postoperative complications occurred in 13 patients (12.26%), with no cases of pleural injury. Factors associated with incomplete stone clearance included a stone surface area of ≥800 mm² (OR 6.747, 95% CI 2.304–19.757, p < 0.001) and a Guy’s Stone Score (GSS) of 4 (OR 6.00, 95% CI 2.312–15.574, p < 0.001).
Conclusion: PCNL using the triangular technique with upper pole renal access through a subcostal incision is an effective and safe surgical method for renal stone removal. The procedure demonstrated high efficacy, no pleural injuries, and acceptable complication rates.
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