Abstract
Purpose: To compare the efficacy of the middle calyx access (MCA) and lower calyx access (LCA) in the treatment of lower pole kidney stones. Materials and Methods: The data of patients with isolated lower pole kidney stones who underwent percutaneous nephrolithotomy via MCA or LCA between 2009 and 2019 were evaluated retrospectively. Pre-, peri-, and postoperative parameters of the groups (LCA group and MCA group) were compared. A value of p < 0.05 was considered significant. Results: A total of 601 patients with lower pole kidney stones were included in the study. LCA was performed for the initial tract in 400 patients, and MCA was performed in 201 patients. There were no significant differences in terms of age, gender, laterality, body mass index, previous operation history, stone burden, duration of fluoroscopy, and stone-free rate between the groups. Operation time was significantly longer in the LCA group (p = 0.041). In the LCA group, additional access was required in 50 cases, which was significantly higher than in the MCA group (p = 0.013). Clinically insignificant residual fragments (CIRF) were present in 28 patients (7%) in the first group (significantly higher vs. MCA: p = 0.044). There were no statistically significant differences in terms of overall complication and transfusion rates. Conclusions: MCA had superior outcomes in terms of operation time, CIRF rate, hemoglobin drop, and requirement of an additional tract compared to LCA. Further studies evaluating the efficacy of MCA in lower pole kidney stones should be performed to verify our results.
References
1.
Turk
C
, Knoll
T
, Petrik
A
, et al. Guidelines on urolithiasis. Arnheim
[NL
]European Association of Urology
; 2015
.2.
Elbahnasy
AM
, Clayman
RV
, Shalhav
AL
, Hoenig
DM
, Chandhoke
P
, Lingeman
JE
, et al. Lower-pole caliceal stone clearance after shockwave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy
. J Endourol
. 1998
Apr
;12
(2
):113
–9
.
[PubMed]
0892-77903.
Li
X
, He
Z
, Wu
K
, Li
SK
, Zeng
G
, Yuan
J
, et al. Chinese minimally invasive percutaneous nephrolithotomy: the Guangzhou experience
. J Endourol
. 2009
Oct
;23
(10
):1693
–7
.
[PubMed]
0892-77904.
Li
X
, Zeng
G
, Liu
J
, He
Y
, He
Z
, Qi
D
. Minimally invasive percutaneous nephrolithotomy in the management of complex urinary calculi: a middle calyx puncture approach
. J Chin Urol
. 2005
;20
:147
–9
.5.
Young
AT
, Hunter
DW
, Castaneda-Zuniga
WR
, Hulbert
JC
, Lange
P
, Reddy
P
, et al. Percutaneous extraction of urinary calculi: use of the intercostal approach
. Radiology
. 1985
Mar
;154
(3
):633
–8
.
[PubMed]
0033-84196.
Levey
AS
, Stevens
LA
, Schmid
CH
, Zhang
YL
, Castro
AF
3rd, Feldman
HI
, et al.; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
. A new equation to estimate glomerular filtration rate
. Ann Intern Med
. 2009
May
;150
(9
):604
–12
.
[PubMed]
0003-48197.
Tefekli
A
, Ali Karadag
M
, Tepeler
K
, Sari
E
, Berberoglu
Y
, Baykal
M
, et al. Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard
. Eur Urol
. 2008
Jan
;53
(1
):184
–90
.
[PubMed]
0302-28388.
de la Rosette
J
, Assimos
D
, Desai
M
, Gutierrez
J
, Lingeman
J
, Scarpa
R
, et al.; CROES PCNL Study Group
. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients
. J Endourol
. 2011
Jan
;25
(1
):11
–7
.
[PubMed]
0892-77909.
Zhang
W
, Zhou
T
, Wu
T
, Gao
X
, Peng
Y
, Xu
C
, Chen
Q
, Song
R
, Sun
Y.
Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shock Wave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-analysis and Systematic Review J Endourol.
2015
;29:745-5910.
Zhang
H
, Hong
TY
, Li
G
, Jiang
N
, Hu
C
, Cui
X
, et al. Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1-2 cm Lower Pole Renal Calculi
. Urol Int
. 2019
;102
(2
):153
–9
.
[PubMed]
0042-113811.
Bozzini
G
, Verze
P
, Arcaniolo
D
, Dal Piaz
O
, Buffi
NM
, Guazzoni
G
, et al. A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience : A better understanding on the treatment options for lower pole stones
. World J Urol
. 2017
Dec
;35
(12
):1967
–75
.
[PubMed]
0724-498312.
Sampaio
FJ
, Aragao
AH
. Anatomical relationship between the intrarenal arteries and the kidney collecting system
. J Urol
. 1990
Apr
;143
(4
):679
–81
.
[PubMed]
0022-534713.
Lojanapiwat
B
, Prasopsuk
S
. Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches
. J Endourol
. 2006
Jul
;20
(7
):491
–4
.
[PubMed]
0892-779014.
Tefekli
A
, Esen
T
, Olbert
PJ
, Tolley
D
, Nadler
RB
, Sun
YH
, Duvdevani
M
, de la Rosette
JJ
. Isolated upper pole access in percutaneous nephrolithotomy, a large-scale analysis from the CROES percutaneous nephrolithotomy global study. J Urol 2013
;189:568e7315.
Nishizawa
K
, Yamada
H
, Miyazaki
Y
, Kobori
G
, Higashi
Y
. Results of treatment of renal calculi with lower-pole fluoroscopically guided percutaneous nephrolithotomy
. Int J Urol
. 2008
May
;15
(5
):399
–402
.
[PubMed]
0919-817216.
Aron
M
, Goel
R
, Kesarwani
PK
, Seth
A
, Gupta
NP
. Upper pole access for complex lower pole renal calculi
. BJU Int
. 2004
Oct
;94
(6
):849
–52
.
[PubMed]
1464-409617.
Oner
S
, Okumus
MM
, Demirbas
M
, Onen
E
, Aydos
MM
, Ustun
MH
, Kilic
M
, Avci
S
. Factors influencing complications of percutaneous nephrolithotomy: a single-center study.
Urol J 2015
; 12:2317e2318.
Falahatkar
S
, Kazemnezhad
E
, Moghaddam
KG
, Kazemzadeh
M
, Asadollahzade
A
, Farzan
A
, et al. Middle calyx access in complete supine percutaneous nephrolithotomy
. Can Urol Assoc J
. 2013
May-Jun
;7
(5-6
):E306
–10
.
[PubMed]
1911-647019.
Song
Y
, Jin
W
, Hua
S
, Fei
X
. Middle calyx access is better for single renal pelvic stone in ultrasound-guided percutaneous nephrolithotomy
. Urolithiasis
. 2016
Oct
;44
(5
):459
–63
.
[PubMed]
2194-722820.
Soares
RMO
, Zhu
A
, Talati
V
, Nadler
RB
. Upper pole access for prone percutaneous nephrolithotomy: advantage or risk?
Urology. 2019
Sep 2. pii: S0090-4295[19]30753-821.
Preminger
GM
, Schultz
S
, Clayman
RV
, Curry
T
, Redman
HC
, Peters
PC
. Cephalad renal movement during percutaneous nephrostolithotomy
. J Urol
. 1987
Apr
;137
(4
):623
–5
.
[PubMed]
0022-534722.
Patel
AP
, Bui
D
, Pattaras
J
, Ogan
K
. Upper pole urologist-obtained percutaneous renal access for PCNL is safe and efficacious
. Can J Urol
. 2017
Apr
;24
(2
):8754
–8
.
[PubMed]
1195-947923.
Singh
V
, Garg
Y
, Sharma
K
, Sinha
RJ
, Gupta
S
. Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones
. Urolithiasis
. 2016
Apr
;44
(2
):161
–5
.
[PubMed]
2194-7228© 2020 S. Karger AG, Basel
2020
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
