Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

Abstract

Objective: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Recent literature suggests that papillary access to renal calyx is the accepted method. Despite this rule, we do not always make papillary puncture and we puncture wherever we can to achieve stone-free status and reduce unnecessary access. In this study, we present our results with papillary vs non-papillary access in patients with a kidney stone. Material and methods: Two hundred and seven patients with non-papillary access and 69 patients with papillary access who had similar demographics (age, body mass index (BMI), stone size) were selected with pair match analysis (3:1). Preoperative and postoperative data were collected from the patient's chart. Operative time (from starting surgery to nephrostomy tube), drop-in hematocrit level, transfusion rate, duration of hospital stay, perioperative and postoperative complications (Clavien-Dindo Classification) and stone-free status (no or < 3 mm residual stone) were also evaluated in both groups. Results: The mean operative time was similar in between two groups. The mean hematocrit decreases not differ between the two groups (p = 0.56). In papillary group, only 2 patients (3.2%) required transfusion and only one patient (1.4%) in the non-papillary group had a transfusion with no statistically significant difference (p = 0.43). The overall complication rates were 7.1% in the papillary group and 7.2% in the non-papillary group (p = 0.89). Postoperative mean creatinine level was similar between the two groups. Conclusions: In this study, we found that non-papillary access is a feasible option for PCNL in the terms of stone-free status and complication rates.

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

“…In contrast, the operative time was significantly shorter in the non-papillary arm. 5 Similar to their results, no statistically significant differences were reported in a retrospective matched-pair case-control study by Tahra et al 6 Out of 69 patients with non-papillary puncture, a blood transfusion was only required in one patient. No significant differences were reported for overall complications.…”

Advances in percutaneous renal puncture: a comprehensive review of the literature

“…Operation time, SFR and length of hospital stay (LOS) were similar between the groups. There were no significant differences concerning overall complication rate, drop in haematocrit level and transfusion rate [9]. As a conclusion, the surgeon must make a personalized decision case by case.…”

Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

“…[ [20] , [21] , [22] ] reporting a significantly higher risk of vessel injury when a non-fornical puncture was undertaken. Nevertheless, the clinical studies on non-papillary punctures have demonstrated their comparable safety and efficiency for standard and mini-PCNL including complex renal stones with multiple PCNL tracts [ [23] , [24] , [25] , [26] ].…”