Percutaneous nephrolithotomy for complex renal calculi: is multi-tract approach ok?

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Complex renal stones, including staghorn or intricate caliceal calculi, pose treatment challenges.
• Percutaneous nephrolithotomy (PCNL) is a primary surgical approach for large or complex kidney stones.
• Comparing single-tract versus multiple-tract PCNL is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate and compare the safety and efficacy of multiple-tract versus single-tract PCNL for complex renal calculi.
• To identify differences in operative outcomes, complications, and stone clearance between the two PCNL approaches.

Main Methods:

• A retrospective analysis of 109 PCNL procedures for unilateral complex renal calculi.
• Patients were divided into two groups: 30 undergoing multiple-tract PCNL and 79 undergoing single-tract PCNL.
• Key outcome measures included operative time, blood loss, serum creatinine changes, transfusion rates, hospital stay, stone clearance, ancillary procedures, and complications.

Main Results:

• No significant differences were found in success rate, operative time, transfusion rate, hemoglobin drop, hospitalization, complication rate, or serum creatinine rise between single-tract and multiple-tract PCNL.
• Multiple-tract PCNL required significantly more ancillary procedures (53.3% vs. 24.1%, p = 0.003).
• No long-term sequelae were observed in either group during a median 24-month follow-up.

Conclusions:

• Multiple-tract PCNL is a safe and effective option for select complex renal stones and patients.
• Single-tract PCNL demonstrated comparable outcomes to multiple-tract PCNL, particularly in patients with less complex stones.
• The choice between single and multiple tracts should consider stone complexity and the potential need for additional procedures.