Single Upper-Pole Percutaneous Access for Treatment of ≥5-cm Complex Branched Staghorn Calculi: Is Shockwave Lithotripsy Necessary?

Abstract

Use of flexible nephroscopy with holmium:YAG laser lithotripsy and Nitinol basket stone extraction has allowed us to render staghorn-containing renal units stone free in a mean of 1.6 procedures. Of the 45 renal units treated through a single percutaneous access, 43 (95%) were rendered stone free. The holmium:YAG laser appears to be a safe lithotrite for the kidney, as no complications occurred from its use.

The Influence of Access on the Efficacy and Complications in PCNL for Renal Calculi

“…Though mortality after PCNL is an extremely rare occurrence, AhmetTefekli et al 21 have reported one death in their series of 811 cases and there were no deaths during the postoperative period in our study.PCNL in ADPKD and horseshoe kidneys have been found to have a satisfactorystone-free rate and acceptable morbidity 22,23 . Though in our study there were only 4 horseshoe kidneys and 4 cases of ADPKD all these patients did not experience any increase in morbidity.…”

Middle calyx access in complete supine percutaneous nephrolithotomy

“…[11][12][13][14][15] Upper calyx access is in the direction of the longitudinal axis of the renal pelvis and provides optimal sight from the upper pole to the lower pole and directly reaches the upper calyx, renal pelvis, uretero-pelvic junction and proximal ureter. 11,12,14,16 However, the risk of intra-thoracic complication increases with this access.…”

“…Access to the collecting system is performed via upper, middle and lower calices. [11][12][13][14][15] Upper calyx access provides a perfect reach to the collecting system and many upper tract stones. However, this access may incur intrathoracic complications.…”

“…However, this access may incur intrathoracic complications. 4,12,[14][15][16][17] Moreover, multiple tracts may be necessary for successful treatment. Lower calyx access is used particularly for lower calyx stones, with minimal risk of intestinal injury.…”

“…5,11,12,18 Middle calyx access has been underused in PCNL, especially in the supine position. [11][12][13][14][15][16][17][18] Whereas middle calyx seems appropriate to access stones in the upper tract. 13,19 In this non-randomized single-surgeon study, we compared the safety and efficacy outcomes between middle calyx and lower calyx accesses in patients with complete supine PCNL.…”