Comparative Evaluation of Upper Versus Lower Calyceal Approach in Percutaneous Nephrolithotomy for Managing Complex Renal Calculi

Overview

Journal Urol Ann

Specialty Urology

Date 2015 Feb 7

PMID 25657540

Citations 11

Authors

Rohit Singh

S P Kankalia

Vilas Sabale

Vikram Satav

Deepak Mane

Abhirudra Mulay

Bhupender Kadyan

Naveen Thakur

Affiliations

Soon will be listed here.

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn and large renal stones. The success of PCNL is highly related to optimal renal access. Upper calyceal puncture being more difficult and more demanding have relatively few studies presented.

Aims And Objectives: This prospective study was carried out to evaluate the effectiveness and safety of upper calyceal versus lower calyceal puncture for the removal of complex renal stones through PCNL.

Materials And Methods: A total of 94 patients underwent PCNL for complex renal stone in our institute. Fifty-one of them underwent lower calyceal, while 43 underwent upper calyceal puncture. The two approaches are compared as per total duration of surgery, intraoperative blood loss, infundibular/pelvic tear, rate of complete clearance and rate of postoperative complications (pulmonary, bleeding, fever and sepsis, etc.).

Observation And Results: In our study, the success rate was 76.47% for those in the lower, 90.70% for those in the upper calyceal access group. Thoracic complications (hydrothorax) occurred to 1 patient in upper calyceal supracostal access group. Bleeding requiring blood transfusion happened to 5 patients in lower calyceal access and 1 in upper calyceal group.

Conclusion: In our study for the management of complex renal calculi, we conclude that in a previously unoperated kidney, upper calyceal puncture through subcostal or supra 12(th) rib is a feasible option minimizing lung/pleural rupture and gives a better clearance rate. We suggest that with due precautions, there should not be any hesitation for upper calyceal puncture in indicated patients.

Citing Articles

Percutaneous nephrostomy for complex renal stones: Percutaneous renal access behind the stone versus renal calyx dilation.

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PMID: 36454857 PMC: 9714915. DOI: 10.1371/journal.pone.0278485.

Superior calyceal access vs. other calyceal access in percutaneous nephrolithotomy: A systematic review and meta-analysis.

Ma Y, Lin L, Luo Z, Jin T Front Surg. 2022; 9:930159.

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Costovertebral angle as a novel tool for predicting the thoracic complication risk following percutaneous nephrolithotomy requiring supracostal access.

Guzel A, Oksay T, Ozturk S, Soyupek A, Ozorak A, Kosar A Can Urol Assoc J. 2021; 15(11):E608-E613.

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Impact Factors and an Efficient Nomogram for Predicting the Occurrence of Sepsis after Percutaneous Nephrolithotomy.

Wang J, Mi Y, Wu S, Shao H, Zhu L, Dai F Biomed Res Int. 2021; 2020:6081768.

PMID: 33426058 PMC: 7772030. DOI: 10.1155/2020/6081768.

Peri-Operative Factors Affecting Blood Transfusion Requirements During PCNL: A Retrospective Non-Randomized Study.

Ketsuwan C, Pimpanit N, Phengsalae Y, Leenanupunth C, Kongchareonsombat W, Sangkum P Res Rep Urol. 2020; 12:279-285.

PMID: 32802804 PMC: 7383108. DOI: 10.2147/RRU.S261888.

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