Comparative Evaluation of the Upper and Lower Calyceal Approaches in Percutaneous Nephrolithotomy for the Treatment of Staghorn Calculus


  • Faqed Faraj Almusawi Arab board of urology C.A.B.S Jordan board of urology J.M.C.S


Percutaneous nephrolithotomy, staghorn, lower and upper calyceal approach


Background: Branched stones called staghorn calculi make up most of the pelvicalyceal
system. For staghorn calculi, percutaneous nephrolithotomy (PCNL) is currently the
recommended first-line treatment option. Optimal renal access is critical to PCNL success.
Objective: to compare between lower and upper calyceal PCNL approaches for treating
staghorn calculus at the renal pelvis and/or lower calyx.
Methods: PCNL was performed on 40 patients with complex renal stones in our center.
Twenty had a lower calyceal puncture, and 20 had upper calyceal access. The two methods are
compared in terms of the overall duration of the procedure, the requirement for a second
puncture, the success rate (residual stone presence), intraoperative blood transfusion rates,
postoperative complication rates, and hospital stay.
Results: The mean operative time in lower access was 64.5±23.73 min which was longer than
that of upper group (50.5±18.88 min) with a significant. Compared to none in the upper calyceal
approach, five patients (20%) in the lower approach require a secondary puncture. Two patients
(10%) in the upper access experienced pneumothorax versus one patient (2%) in the lower access
experienced angioembolization. There is no difference in the duration of hospital stays between
the two methods.
Conclusion: The upper calyceal approach, with minimizes lung complications and requires a
short surgical time, is a feasible option for pelvic and/or lower calyceal renal calculi.


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