Multiperc versus single perc with flexible instrumentation for staghorn calculi

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a key technique for kidney stone removal.
• The choice between single-tract and multiple-tract PCNL depends on stone burden, anatomy, and surgeon expertise.
• Ongoing debate exists regarding the optimal PCNL strategy for complete stone clearance.

Purpose of the Study:

• To compare the efficacy and outcomes of single-tract versus multiple-tract PCNL.
• To evaluate the role of flexible instrumentation in PCNL procedures.
• To identify the need for further comparative studies in PCNL.

Main Methods:

• Review of existing literature comparing single-tract and multiple-tract PCNL approaches.
• Discussion of instrumentation, surgical technique, and associated morbidities.
• Analysis of reported stone clearance rates, bleeding, and hospital stay.

Main Results:

• Multiple-tract PCNL may offer stone clearance without costly instrumentation, with no proven increase in bleeding.
• Single-tract PCNL without flexible instruments is suitable for smaller stones.
• Single-tract PCNL with flexible instruments may have suboptimal clearance despite shorter stays and less blood loss.

Conclusions:

• The current literature, largely retrospective, is insufficient to definitively conclude the superiority of single-tract or multiple-tract PCNL.
• Further prospective, comparative studies are essential to establish the advantages and disadvantages of each approach.
• Staghorn calculi and complete stone clearance remain challenging areas requiring more research.