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A Comparison of Perioperative Stone-Free Rates and Complications Following Unilateral, Single-Access Percutaneous Nephrolithotomy by Access Location in 767 Patients

      Abstract

      Objective

      To compare perioperative outcomes between lower, mid, and upper pole access locations for patients undergoing single-access, unilateral percutaneous nephrolithotomy (PCNL).

      Methods

      We queried our institutional PCNL database to include patients who had unilateral, single access procedures. We excluded patients who had a contralateral procedure during the same admission or multiaccess procedures. Patients were grouped by the site of PCNL access (lower, mid, or upper pole). Among groups, we compared postoperative day 1 (POD1) stone-free rates as measured by abdominal CT scan or plain-film X-ray and consequent need for a secondary procedure. We further compared postoperative complication rates.

      Results

      We included 767 patients for analysis, with the majority of access locations being in the lower pole (80.2%). Patients across groups had similar age, body mass index, and stone laterality. Patients with horseshoe kidneys more commonly had mid or upper pole access compared to lower pole. The percentage of patients with no residual stone fragments seen on POD 1 imaging was similar for lower, mid, and upper pole groups (57.7% vs 65.0% vs 61.6%, respectively; P = .526). Additionally, we observed no difference in the percentage of patients requiring a secondary procedure among the above groups (33.5% vs 22.5% vs 31.3%, respectively; P = .337). Patients experienced no difference in complications among groups.

      Conclusion

      When performing unilateral PCNL using a single site of access, we observed no difference in stone-free rates or complications between lower, mid, and upper pole locations. Appropriate selection of access location in PCNL should be individualized to patient factors and surgeon experience.
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      References

        • Assimos D
        • Krambeck A
        • Miller NL
        • et al.
        Surgical management of stones: American Urological Association/Endourological Society Guideline, PART I.
        J Urol. 2016; 196: 1153-1160https://doi.org/10.1016/j.juro.2016.05.090
        • de la Rosette J
        • Assimos D
        • Desai M
        • et al.
        The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.
        J Endourol. 2011; 25: 11-17https://doi.org/10.1089/end.2010.0424
        • Duvdevani M
        • Razvi H
        • Sofer M
        • et al.
        Third prize: contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients.
        J Endourol. 2007; 21: 824-829https://doi.org/10.1089/end.2007.9936
        • Miller NL
        • Matlaga BR
        • Lingeman JE
        Techniques for fluoroscopic percutaneous renal access.
        J Urol. 2007; 178: 15-23https://doi.org/10.1016/j.juro.2007.03.014
        • Kyriazis I
        • Panagopoulos V
        • Kallidonis P
        • Özsoy M
        • Vasilas M
        • Liatsikos E
        Complications in percutaneous nephrolithotomy.
        World J Urol. 2015; 33: 1069-1077https://doi.org/10.1007/s00345-014-1400-8
        • Song Y
        • Jin W
        • Hua S
        • Fei X
        Middle calyx access is better for single renal pelvic stone in ultrasound-guided percutaneous nephrolithotomy.
        Urolithiasis. 2016; 44: 459-463https://doi.org/10.1007/s00240-016-0866-9
        • Li X
        • He Z
        • Wu K
        • et al.
        Chinese minimally invasive percutaneous nephrolithotomy: the Guangzhou experience.
        J Endourol. 2009; 23: 1693-1697https://doi.org/10.1089/end.2009.1537
        • Falahatkar S
        • Kazemnezhad E
        • Moghaddam KG
        • et al.
        Middle calyx access in complete supine percutaneous nephrolithotomy.
        Can Urol Assoc J J Assoc Urol Can. 2013; 7: E306-E310https://doi.org/10.5489/cuaj.11307
        • El Tayeb MM
        • Knoedler JJ
        • Krambeck AE
        • Paonessa JE
        • Mellon MJ
        • Lingeman JE
        Vascular complications after percutaneous nephrolithotomy: 10 years of experience.
        Urology. 2015; 85: 777-781https://doi.org/10.1016/j.urology.2014.12.044
        • Dindo D
        • Demartines N
        • Clavien P-A
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Binbay M
        • Akman T
        • Ozgor F
        • et al.
        Does pelvicaliceal system anatomy affect success of percutaneous nephrolithotomy?.
        Urology. 2011; 78: 733-737https://doi.org/10.1016/j.urology.2011.03.058
        • Verma A
        • Tomar V
        • Yadav S
        Complex multiple renal calculi: stone distribution, pelvicalyceal anatomy and site of puncture as predictors of PCNL outcome.
        SpringerPlus. 2016; 5: 1356https://doi.org/10.1186/s40064-016-3017-4
        • Blackburne AT
        • Rivera ME
        • Gettman MT
        • Patterson DE
        • Krambeck AE
        Endoscopic management of urolithiasis in the horseshoe kidney.
        Urology. 2016; 90: 45-49https://doi.org/10.1016/j.urology.2015.12.042
        • Miller NL
        • Matlaga BR
        • Handa SE
        • Munch LC
        • Lingeman JE
        The presence of horseshoe kidney does not affect the outcome of percutaneous nephrolithotomy.
        J Endourol. 2008; 22: 1219-1225https://doi.org/10.1089/end.2008.0051
        • Skoog SJ
        • Reed MD
        • Gaudier FA
        • Dunn NP
        The posterolateral and the retrorenal colon: implication in percutaneous stone extraction.
        J Urol. 1985; 134: 110-112
        • Kim SC
        • Kuo RL
        • Tinmouth WW
        • Watkins S
        • Lingeman JE
        Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach.
        J Urol. 2005; 173: 1194-1198https://doi.org/10.1097/01.ju.0000152320.41995.c2
        • Mulţescu R
        • Georgescu D
        • Drăguţescu M
        • Geavlete PA
        • Geavlete B
        Chapter 4 - percutaneous approach of caliceal diverticula.
        in: Geavlete PA Percutaneous Surgery of the Upper Urinary Tract. Academic Press, San Diego2016: 105-112
        • Shahrour K
        • Tomaszewski J
        • Ortiz T
        • et al.
        Predictors of immediatepostoperative outcome of single-tract percutaneous nephrolithotomy.
        Urology. 2012; 80: 19-25https://doi.org/10.1016/j.urology.2011.12.065
        • Tefekli A
        • Esen T
        • Olbert PJ
        • et al.
        Isolated upper pole access in percutaneous nephrolithotomy: a large-scale analysis from the CROES percutaneous nephrolithotomy global study.
        J Urol. 2013; 189: 568-573https://doi.org/10.1016/j.juro.2012.09.035
        • Aron M
        • Yadav R
        • Goel R
        • et al.
        Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi.
        Urol Int. 2005; 75: 327-332https://doi.org/10.1159/000089168
        • Akman T
        • Sari E
        • Binbay M
        • et al.
        Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses.
        J Endourol. 2010; 24: 955-960https://doi.org/10.1089/end.2009.0456
        • Wong C
        • Leveillee RJ
        Single upper-pole percutaneous access for treatment of >or = 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary?.
        J Endourol. 2002; 16: 477-481https://doi.org/10.1089/089277902760367430
        • Ganpule AP
        • Vijayakumar M
        • Malpani A
        • Desai MR
        Percutaneous nephrolithotomy (PCNL) a critical review.
        Int J Surg Lond Engl. 2016; 36: 660-664https://doi.org/10.1016/j.ijsu.2016.11.028