Papillary vs Nonpapillary Puncture in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) traditionally accesses renal stones via the renal calix papilla.
• An infundibular approach for PCNL is considered potentially riskier due to increased hemorrhagic risk.
• This study aimed to evaluate the safety of the infundibular approach for PCNL.

Purpose of the Study:

• To compare the safety and efficacy of the infundibular versus papillary renal access for percutaneous nephrolithotomy (PCNL).
• To investigate the primary outcome of blood loss, measured by hemoglobin reduction and transfusion rates.
• To assess secondary outcomes including operative time, complication rates, and hospitalization duration.

Main Methods:

• A prospective randomized study comparing papillary (Group 1) and infundibular (Group 2) renal access for PCNL in patients with stones ≥2 cm.
• Primary outcome measures: postoperative hemoglobin reduction and transfusion rates within one month.
• Secondary outcome measures: operative/fluoroscopy time, number of accesses, complication rates up to 3 months, and hospitalization time.

Main Results:

• No significant difference in hemoglobin reduction or transfusion rates between the papillary and infundibular groups (p=0.916, p=1.0).
• Operative time was significantly longer for the papillary approach (p=0.027).
• Overall complication rates were similar (7.4% for Group 1 vs. 7.14% for Group 2), with no significant difference in hospitalization time (p=0.724).

Conclusions:

• The infundibular approach for PCNL to posterior middle renal calices is a safe alternative.
• It is not associated with increased blood loss or transfusion rates compared to the papillary approach.
• The findings support the infundibular approach when using the described technique.