Article Sidebar

Submitted
May 17, 2024
Accepted
May 17, 2024
Published
May 17, 2024
Download
pdf
Statistic
Read Counter : 665 Download : 229

Main Article Content

Abstract

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.

Keywords

Percutaneous nephrolithotomy staghorn lower and upper calyceal approach

Article Details

License

Copyright (c) 2024 University of Thi-Qar Journal Of Medicine

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Torricelli FCM, Monga M. Staghorn renal stones: what the urologist needs to know. Int Braz J
  2. Urol. 2020; 46(6):927-933.
  3. Koga S, Arakaki Y, Matsuoka M, Ohyama C. Staghorn calculi--long-term results of management.
  4. Br J Urol. 1991; 68:122-4.
  5. Rieu P. Infective lithiasis. Ann Urol (Paris). 2005; 39:16-29; Flannigan R, Choy WH, Chew B,
  6. Lange D. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev
  7. Urol. 2014; 11:333-341.
  8. Kader K., Finelli A., Honey J., et al.: Nephroureterostomy-drained percutaneous
  9. nephrolithotomy: Modification combining safety with decreased morbidity. J Endourol. 2004; 18:29-32.
  10. Osman M., Wendt G., Heger K., et al. Percutaneous nephrolithotomy with ultrasonographyguided renal access: Experience from over 300 cases. Br J Urol Int. 2005; 96:875-878.
  11. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on
  12. interventional treatment for urolithiasis. Eur Urol. 2016; 69:475-482.
  13. Ganpule AP, Naveen Kumar Reddy M, Sudharsan SB, Shah SB, Sabnis RB, Desai MR.
  14. Multitract percutaneous nephrolithotomy in staghorn calculus. Asian J Urol. 2020; 7(2):94-101.
  15. Özgör F, Küçüktopcu O, Şimşek A, Sarılar Ö, Binbay M, Gürbüz G. Percutaneous
  16. nephrolithotomy for isolated calyceal stones: how important is the stone location? Turk J Urol. 2015;
  17. (4):171-176.
  18. Sofer M, Giusti G, Proietti S, Mintz I, Kabha M, Matzkin H, Aviram G. Upper calyx
  19. approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J
  20. Urol. 2016; 195(2):377-382.
  21. Sofer M, Barghouthy Y, Bar-Yosef Y, Mintz I, Proietti S, Tsemah R, Horkin A, Matzkin H,
  22. Giusti G. Upper calyx accessibility through a lower calyx access is not influenced by morphometric and
  23. clinical factors in supine percutaneous nephrolithotomy. J Endourol. 2017; 31(5):452-456.
  24. Lingeman JE, Lifshitz DA, Evan AP. Surgical management of urinarylithiasis. In: Walsh PC,
  25. Retik AB, Vaughan ED, editors. Campbell's Urology. Philadelphia: WB Saunders Company; 2002. pp.
  26. -451.
  27. Clayman RV, Surya V, Miller RP, et al. Percutaneous nephrolithotomy. An approach to branched
  28. and staghorn renal calculi. JAMA. 1983; 250:73-75.
  29. Ma Y, Lin L, Luo Z, Jin T. Superior calyceal access vs. other calyceal access in percutaneous
  30. nephrolithotomy: A systematic review and meta-analysis. Front Surg. 2022; 9:930159.
  31. Amaresh M, Hegde P, Chawla A, de la Rosette JJMCH, Laguna MP, Kriplani A. Safety and
  32. efficacy of superior calyceal access versus inferior calyceal access for pelvic and/or lower calyceal renal
  33. calculi- a prospective observational comparative study. World J Urol. 2021 Jun;39(6):2155-2161.
  34. Yuan D, Liu Y, Rao H, Cheng T, Sun Z, Wang Y, Liu J, Chen W, Zhong W, Zhu J. Supine
  35. versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol.
  36. ; 30(7):754-763.
  37. Patel RM, Okhunov Z, Clayman RV, Landman J. Prone versus supine percutaneous
  38. nephrolithotomy: what is your position? Curr Urol Rep. 2017; 18(4):26.
  39. Singh R, Kankalia SP, Sabale V, Satav V, Mane D, Mulay A, Kadyan B, Thakur N. Comparative
  40. evaluation of upper versus lower calyceal approach in percutaneous nephrolithotomy for managing
  41. complex renal calculi. Urol Ann. 2015; 7(1):31-35.
  42. Aron M, Goel R, Kesarwani PK, Seth A, Gupta NP. Upper pole access for complex lower pole
  43. renal calculi. BJU Int. 2004; 94:849-852.
  44. Netto NR, Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for
  45. staghorn calculi. Urology. 2005; 65:659-662.
  46. Lojanapiwat B, Prasopsuk S. Upper-pole access for percutaneous nephrolithotomy: Comparison
  47. of supracostal and infracostal approaches. J Endourol. 2006; 20:491-494.
  48. Sukumar S, Nair B, Ginil KP, Sanjeevan KV, Sanjay BH. Supracostal access for percutaneous
  49. nephrolithotomy: Less morbid, more effective. Int Urol Nephrol. 2008; 40:263-267.
  50. Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U, Tolley D. Incidence,
  51. prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol. 2012;
  52. (1):146-158.
  53. Kyriazis I, Panagopoulos V, Kallidonis P, Özsoy M, Vasilas M, Liatsikos E. Complications in
  54. percutaneous nephrolithotomy. World J Urol. 2015; 33(8):1069-1077

Similar Articles

You may also start an advanced similarity search for this article.