Comparison of Efficacy and Safety of Isolated Single Different Calyx Accesses in Percutaneous Nephrolithotomy

Abstract

What's known on the subject? and What does the study add? We investigated whether there was superiority in different calyceal accesses performed in percutaneous nephrolithotomy operation for renal stone treat. Amaç: Böbrek taşı tedavisinde uygulanan perkütan nefrolitotomi (PNL) operasyonunda izole ve tek giriş olarak yapılan üst, orta ve alt kaliks girişlerinin güvenlik ve etkinliklerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Kliniğimizde Eylül 2007 ve Haziran 2018 tarihleri arasında böbrek taşı nedeniyle izole tek giriş ile PNL yapılan hastalar retrospektif olarak incelendi. Hastalar izole tek üst kaliks girişi (grup 1), izole tek orta kaliks girişi (grup 2) ve izole tek alt kaliks girişi (grup 3) olmak üzere üç gruba ayrıldı. Hastaların demografik özelikleri, taş boyutu ve lokalizasyonu, operasyona ait veriler, postoperatif sonuçlar ve komplikasyonlar açısından karşılaştırıldı. Öz Objective: We aimed to compare the safety and efficacy of upper, middle and lower calyx accesses obtained as isolated and single access in percutaneous nephrolithotomy (PCNL) operation which is performed for treating renal stones. Materials and Methods: The records of patients who had undergone PCNL via isolated single pole access due to renal stone between September 2007 and June 2018 were retrospectively evaluated. The patients were divided into three groups as isolated single upper calyceal access patients (group 1), isolated single middle calyceal access patients (group 2) and isolated single lower calyceal access patients (group 3). The patient groups were compared in terms of patient characteristics, stone size and location, operative data, postoperative outcomes and complications. Results: Fifty-seven (2.8%) patients who underwent isolated single calyceal access PCNL were included in group 1 (upper calyx), 542 (26.9%) in group 2 (middle calyx) and 1427 (70.4%) were included in group 3 (lower calyx). The mean age of the patients in groups 1, 2 and 3 was 43.09±15.00, 38.23±22.47 and 39.40±19.93, respectively. A thousand hundred and seventy-six (58%) patients were male and 850 (42%) were female. The mean stone burden was 367.19±266.48, 335.7±301.85 and 353.73±346.47 mm2 in groups 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.45, p=0.77, p=0.29, respectively). The mean operative time, mean fluoroscopy time, and mean nephrostomy time, and the mean length of hospitalization were statistically significantly longer in group 2 than in group 3. Stone-free rates in patients with clinically insignificant stones (SF + CIRF) were 89.5%, 89.6% and 91.6% in group 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.25, p=0.43 and p=0.6 respectively). There was no significant difference between the three groups in terms of postoperative fever, blood transfusion and overall complications. Conclusion: As a result, different isolated single calyceal accesses do not have superiority over each other in terms of stone-free rate and complica...