Isolated upper pole access in percutaneous nephrolithotomy: a large-scale analysis from the CROES percutaneous...

Area of Science:

• Urology
• Nephrolithotomy
• Endourology

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
• Upper pole access in PCNL is an alternative approach for specific stone burdens and locations.
• Understanding the outcomes of upper pole access is crucial for optimizing patient care.

Purpose of the Study:

• To analyze the indications for and outcomes of percutaneous nephrolithotomy (PCNL) specifically using upper pole access.
• To compare the preoperative characteristics and outcomes of patients undergoing PCNL with upper versus lower pole access.

Main Methods:

• Prospective data from 4,494 patients at 96 global centers were collected between 2007 and 2009.
• Patients were categorized into upper and lower pole access groups based on the site of renal access.
• Univariate and multivariate tests were used to compare patient characteristics and outcomes between the groups.

Main Results:

• The upper pole access group had a higher prevalence of staghorn stones and a greater stone burden.
• Mean operative time was longer for upper pole access (92.4 min vs. 75.1 min).
• The stone-free rate was lower in the upper pole group (77.1% vs. 81.6%), with a higher overall complication rate, including more hydrothorax but less pelvic perforation. Mean hospital stay was also longer.

Conclusions:

• Isolated upper pole access is indicated for select patients with complex stones, such as upper calyceal and staghorn calculi.
• This approach is associated with increased operative complexity, leading to a higher complication rate and longer hospital stay.
• While effective for specific indications, upper pole access in PCNL yields a lower stone-free rate compared to lower pole access.