Middle calyx access in complete supine percutaneous nephrolithotomy.
Siavash Falahatkar1, Ehsan Kazemnezhad, Keivan Gholamjani Moghaddam
1Urology Research Center, Guilan University of Medical Sciences, Urology Research Center, Razi Hospital, Rasht, I.R. Iran.
Summary
Middle calyx access in supine percutaneous nephrolithotomy (PCNL) offers superior outcomes. This study found it led to shorter operative times and hospital stays compared to lower calyx access.
Area of Science:
- Urology
- Surgical Techniques
- Nephrolithotomy
Background:
- Middle calyx access is underutilized in percutaneous nephrolithotomy (PCNL), particularly in the supine position.
- This study compares middle calyx versus lower calyx access in complete supine PCNL.
Purpose of the Study:
- To evaluate the safety and efficacy of middle calyx versus lower calyx access in complete supine PCNL.
- To determine if middle calyx access offers advantages in operative time, complications, and stone-free rates.
Main Methods:
- A non-randomized clinical study involving 170 patients undergoing supine PCNL.
- Patients were divided into middle calyx (n=48) and lower calyx (n=122) access groups.
- Key parameters including operative time, hospital stay, hemoglobin drop, stone-free rate, and complication rates were compared.
Main Results:
- Middle calyx access showed significantly shorter operative times (60.7 vs. 80.1 min), hospital stays (1.84 vs. 2.19 days), and hemoglobin drop (0.67 vs. 1.36 g/dL).
- The middle calyx group had a higher stone-free rate (89.6% vs. 76.2%) and efficiency quotient.
- Complication and transfusion rates were lower in the middle calyx group, though not statistically significant.
Conclusions:
- Middle calyx access is an optimal choice for supine PCNL for various upper urinary tract stones.
- It demonstrates superior outcomes in terms of efficiency and patient recovery compared to lower calyx access.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
01:26Kidney Transplant II: Surgical Procedure
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
01:30Urinary Tract Calculi III: Medical Management
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
01:28Urinary Tract Calculi V: Nursing Management
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...