## **Core Concept**
Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove kidney stones. The approach for PCNL involves accessing the kidney through the back, typically through a specific intercostal space to avoid complications. The intercostal spaces are numbered based on their position relative to the ribs.

## **Why the Correct Answer is Right**
The 11th intercostal space is significant because it is generally considered safe for PCNL access. However, access through spaces higher than the 12th intercostal space, such as the 11th intercostal space, increases the risk of **pleural injury**. The pleura extends lower in the posterior chest than in the anterior chest, and accessing the kidney through spaces above the 12th rib increases the risk of entering the pleural space.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, incorrect options might include complications not directly related to the access site, such as renal vascular injury or ureteric obstruction.
- **Option B:** Similarly, without the content, we assume it's incorrect based on the context of the question and the provided correct answer.
- **Option C:** Again, assuming this is incorrect, as the focus is on a specific complication related to the access site.
- **Option D:** This option is stated as the correct answer but without content; we infer its correctness based on the context.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the **12th rib** is a landmark for PCNL access. Access below this rib generally reduces the risk of pleural injury. When performing PCNL, understanding the anatomy and the typical access points can significantly minimize complications.

## **Correct Answer:** D. Pleural injury.