Question:
Which of the following is a complication of PCNL done through the 11th intercostal space, EXCEPT:
Which of the following is a complication of PCNL done through the 11th intercostal space, EXCEPT:
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Going above the 11th rib brings the needle near the pleura, so think chest complications.
Updated On: Jun 24, 2026
- Hydrothorax
- Hematuria
- Damage to colon
- Remnant fragments
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The Correct Option is A
Solution and Explanation
Step 1: Understand the question. This is a negative (EXCEPT) question. Three options are genuine complications of supracostal percutaneous nephrolithotomy (PCNL); one is the odd answer that is NOT typically counted among them.
Step 2: Recall the supracostal access risk. When the tract is made above the 11th rib (11th intercostal space), the puncture crosses the pleural reflection. This is exactly why thoracic complications such as hydrothorax, pleural effusion, hydropneumothorax and pneumothorax are the classic and feared risks of this approach.
Step 3: Resolve the wording. Because hydrothorax is in fact the hallmark complication of the supracostal route, this appears to be a recall/transcription issue: as written, hydrothorax is being singled out as the answer (printed key A) even though it is a true complication. The intended teaching point is that the supracostal tract endangers the pleura. The printed key is retained as given because that is the recorded answer for this recall.
Step 4: Note the genuine complications. Haematuria is common to any PCNL because the tract passes through vascular renal parenchyma. Colonic injury can occur with a retrorenal colon, particularly on the left. Residual (remnant) stone fragments are a recognised problem after any stone-clearance procedure.
Answer: Hydrothorax (Option A), as per the recorded key.
Step 2: Recall the supracostal access risk. When the tract is made above the 11th rib (11th intercostal space), the puncture crosses the pleural reflection. This is exactly why thoracic complications such as hydrothorax, pleural effusion, hydropneumothorax and pneumothorax are the classic and feared risks of this approach.
Step 3: Resolve the wording. Because hydrothorax is in fact the hallmark complication of the supracostal route, this appears to be a recall/transcription issue: as written, hydrothorax is being singled out as the answer (printed key A) even though it is a true complication. The intended teaching point is that the supracostal tract endangers the pleura. The printed key is retained as given because that is the recorded answer for this recall.
Step 4: Note the genuine complications. Haematuria is common to any PCNL because the tract passes through vascular renal parenchyma. Colonic injury can occur with a retrorenal colon, particularly on the left. Residual (remnant) stone fragments are a recognised problem after any stone-clearance procedure.
Answer: Hydrothorax (Option A), as per the recorded key.
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