Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones

Abstract

The objective of this study is to assess the efficacy of superior calyceal access versus inferior calyceal access for inferior calyceal calculi with or without pelvic calculi. A total of 100 patients with inferior calyceal calculi or inferior calyceal calculi with pelvic calculi were included in this prospective randomized study. In 50 patients (Group 1), a fluoroscopy-assisted superior calyceal puncture was made, and in other 50 patients (Group 2), access was obtained through a fluoroscopy-assisted inferior calyceal puncture. The stone-free rates, hemoglobin drop, operative duration, requirement for additional tracts, complications, and auxiliary procedures in the two groups were compared. Stone clearance rates and hemoglobin drop values were better in group 1, though they were not statistically significant. The mean operative duration, number of tracts required, and the relook procedure rate were significantly in favor of Group 1. Only one patient (2%) in Group 1 developed hydropneumothorax related to supracostal puncture and required intercostal tube drainage. Superior calyceal puncture (supracostal or infracostal) provides favorable access to inferior calyceal stones, providing better and faster clearance with less requirement of secondary tracts and auxiliary procedures.

Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and/or lower calyceal renal calculi- a prospective observational comparative study

“…Stone free rates from isolated pelvic and lower calyceal calculi were significantly higher in superior calyceal group than inferior calyceal group. Overall, stone clearance rates are consistent with previous studies for superior calyceal access [2,9,13].…”

“…With the advent of miniaturized access tracts and thereby minimal postoperative complications, PCNL dominates the treatment modalities for larger sized and/or complex renal stone management [1]. One of the major advantages of PCNL over other techniques is the higher stone clearance [2]. A key requisite to a successful procedure is establishing an optimal direct and safe access to the intrarenal collecting system facilitating ease of intrarenal navigation resulting in complete stone clearance.…”

“…Traditionally, the posterior inferior calyceal access is considered as the safest percutaneous access to the intrarenal collecting system and is widely practiced by the majority for stones in the renal pelvis, lower calyx and staghorn stones [2][3][4]. However, this may not be an ideal access for urinary stone removal in all circumstances.…”

Percutaneous Nephrolithotomy via a Middle Calyx Access Is Effective in the Treatment of Lower Pole Kidney Stones: A Single-Center Study

“…It was shown that the upper calyx access is more favorable for the treatment of complex lower pole stones than LCA [16]. Singh et al [23] compared the outcomes of LCA and the upper calyx access in the treatment of lower pole stones. A second puncture was needed in 10% of the patients in the LCA group while it was not needed in any patient in the upper calyx group.…”

Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

“…While standardising for the experience level of the surgeon, variation in the institution-specific sophistication of instrumentation [24], and the difference in surgical approach (in terms of access tract location, tract size, and a number of punctures) [1,25].…”