Isolated Upper Pole Access in Percutaneous Nephrolithotomy: A Large-Scale Analysis from the CROES Percutaneous Nephrolithotomy Global Study

Tefekli̇, Ahmet; Esen, Tarık; Olbert, P.; Tolley, David A.; Nadler, Robert B.; Sun, Yinghao; Duvdevani, Mordechai; Rosette, Jean J.M.C.H. de la

doi:10.1016/j.juro.2012.09.035

Cited by 48 publications

(41 citation statements)

References 23 publications

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“…Moreover, prolonged hospital stay is reported in the upper calyx access cases. 3 Nevertheless, the mean length of hospitalization in our study is longer than the average one based on available bibliography. This paradox is due to 2 reasons.…”

Section: Cuaj -Original Research Sfoungaristos Et Al: Treating Staghocontrasting

confidence: 59%

“…Additionally, complication rates, especially those of thoracic problems and bleeding, are significantly more common during PCNL through the upper pole calyx compared with a lower calyx approach. 3 Regarding our series, 2 out of 103 studied patients were transfused due to bleeding (transfusion rate: 1.9% compared to 9% reported in CROES PCNL study) while no chest complications were observed. Moreover, prolonged hospital stay is reported in the upper calyx access cases.…”

Section: Cuaj -Original Research Sfoungaristos Et Al: Treating Staghomentioning

confidence: 54%

“…2 Nevertheless, lower calyceal access and single-tract accesses are associated with a lower complication rate and shorter hospital stay. 3,4 Thus, combining the safety of a single lower calyceal tract with high SFRs would be an optimal scenario. The aim of the present study is to evaluate the effectiveness and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by PCNL.…”

Section: Introductionmentioning

confidence: 99%

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Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

Sfoungaristos

Mykoniatis

Katafigiotis

et al. 2017

CUAJ

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Introduction: We evaluated the efficacy and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by percutaneous nephrolithotomy. Methods: The medical records of patients who underwent percutaneous nephrolithotomy for the management of staghorn stones were analyzed. We included patients aged >18 years, while patients with incomplete data and renal anatomical anomalies were excluded from the study. Stone-free rate, postoperative complications, procedure duration, fluoroscopy time, and length of hospitalization were recorded. Postoperative outcomes were evaluated by non-contrast computed tomography scan 4-6 weeks after the operation. Stone-free status was defined as the absence of residual stones >4 mm. Results: The study cohort consisted of 103 consecutive patients. Stone-free rate was 65.0%. No complications were observed in 69.9% of the cases; most postoperative complications were Grade 1 (13.6%) and 2 (10.7%). Five patients (4.9%) suffered a Grade 3a complication and another patient (1.0%) suffered a Grade 3b complication. Conclusions: Percutaneous nephrolithotomy through a single lower calyceal tract combined with flexible nephroscopy can be a valuable treatment option for the treatment of staghorn calculi, providing efficacy and safety. Nevertheless, the present study is limited by both its retrospective nature and being conducted at a single centre and, thus, proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach.

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Section: Cuaj -Original Research Sfoungaristos Et Al: Treating Staghocontrasting

confidence: 59%

Section: Cuaj -Original Research Sfoungaristos Et Al: Treating Staghomentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

Sfoungaristos

Mykoniatis

Katafigiotis

et al. 2017

CUAJ

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“…[15] Residual stone, n (%) 21 (6.9%) 1 (7.1%) 6 (11.9%) CIRF, n (%) 35 (11.2%) 0 4 (9.5%) CIRF: clinically insignificant stone fragments Considering renal perfusion, it has been reported that anterior segmental arteries are more exposed to trauma during upper calyceal access. [16,17] Tefekli et al [18] investigated outcomes of 4494 PNL operations, and analyzed patients who had undergone single access PNLs performed for upper, and lower calyces. They indicated that middle calyceal access was not preferred much, and technically it resembled lower calyceal access because of anatomic similarities.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy for isolated calyceal stones: How important is the stone location?

Özgör

Küçüktopçu

Şimşek

et al. 2015

Turkish Journal of Urology

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Objective: To evaluate the effect of percutaneous access site on the success and complication rates of isolated calyceal stones. Material and methods:We retrospectively evaluated 2700 patients who underwent percutaneous nephrolithotomy (PNL) in our clinic between October 2002 and August 2014. We selected only the patients with isolated lower, middle or upper calyceal stones and we grouped the patients according to the location of their stones. Successful operation was defined as complete stone clearence or retention of stone fragments smaller than 4 mm which do not lead to infection, obstruction or pain requiring treatment. Intraoperative and postoperative complications were also recorded.Results: Totally 360 patients underwent PNL for their isolated upper, middle and lower calyceal stones. Access sites for those patients were selected based on stone location. The stones were localized in the lower (n=304), middle (n=14), and upper (n=42) calices. There was no statistically significant difference between the groups with respect to operation and scopy times. Hemoglobin drop was seen more frequently in the upper calyceal access group, without any significant intergroup difference. Thoracic complications including hemothorax, pneumothorax and pleural effusion were more common in the upper calyceal access group (11.9%; p<0.001). Complete stone clerance was accomplished in 81.9%, 92.9% and 78.6% of the patients with lower, middle and upper calyceal stones respectively without any significant intergroup difference (p=0.537). Conclusion:PNL is an effective and safe treatment modality for isolated calyceal kidney stones and upper calyceal access causes thoracic complications more than other access sites.

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“…The incidence of pleural injury (hydrothorax, pneumothorax, hemothorax, and urinothorax) is less than 0.5% when percutaneous access is below the 12 th rib (7-9). Percutaneous access above the 12 th rib on average has a 4.6% injury rate, while access above the 11 th rib is 24.6% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Due to the increased risk of injury, formal chest radiography is recommended following cases of supracostal percutaneous renal access.…”

Section: Introductionmentioning

confidence: 99%

Small bore catheter drainage of pleural injury after percutaneous nephrolithotomy: feasibility and outcome from single large institution series

Benson¹,

Hart²,

Kadlec³

et al. 2013

Journal of Endourology

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Isolated Upper Pole Access in Percutaneous Nephrolithotomy: A Large-Scale Analysis from the CROES Percutaneous Nephrolithotomy Global Study

Cited by 48 publications

References 23 publications

Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

Percutaneous nephrolithotomy for isolated calyceal stones: How important is the stone location?

Small bore catheter drainage of pleural injury after percutaneous nephrolithotomy: feasibility and outcome from single large institution series

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