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

To compare the safety and efficacy of multiple-tract percutaneous nephrolithotomy (PCNL) with single-tract PCNL for complex renal stones.

A total of 109 consecutive PCNL procedures for unilateral complex renal calculi (staghorn or complex caliceal calculi) were performed at our institution. Thirty patients received multiple-tract PCNL and 79 patients underwent single-tract PCNL. The two groups had comparable demographic data except for a smaller stone burden and fewer complete staghorn calculi in those undergoing single-tract PCNL. Variables of interest included operative time, blood loss, change of serum creatinine, transfusion rates, length of hospital stay, stone clearance, number of ancillary procedures, and complication rates.

The number of tracts used for multiple-tract PCNL was two tracts in 20 patients, three tracts in 9, and four tracts in 1. Significant differences were not observed when the single-tract PCNL results were compared with the multiple-tract PCNL in terms of success rate, operative time, transfusion rate, drop in hemoglobin, hospitalization time, complication rate, and rise in serum creatinine. The need for ancillary procedures was more common in patients undergoing multiple-tract PCNL (53.3% versus 24.1%; p = 0.003). No long-term sequela were noted during the median follow up of 24 months in any patient.

The results of the present study show that multi-tract PCNL for appropriately chosen stones/patients has similar safety and effectiveness as single PCNL in patients with smaller and less complex stones.