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Upper Pole Access for Prone Percutaneous Nephrolithotomy: Advantage or Risk?

Ricardo M O Soares1, Alec Zhu2, Vidit M Talati3

  • 1Department of Urology, Northwestern Medicine Regional Medical Group, Winfield, IL; Department of Urology, Northwestern University - Feinberg School of Medicine, Chicago, IL.

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Summary
This summary is machine-generated.

Upper pole access in percutaneous nephrolithotomy (PCNL) is safe and effective, especially when performed below the ribs. Supracostal access improves stone-free rates for complex stones but increases the risk of hydrothorax.

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Area of Science:

  • Nephrology
  • Urology
  • Surgical Outcomes

Background:

  • Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
  • Upper pole access is sometimes avoided due to concerns about pleural injury.

Purpose of the Study:

  • To evaluate the safety and efficacy of upper pole access during PCNL.
  • To compare outcomes between supracostal upper calyx, subcostal upper calyx, and non-upper calyx access.

Main Methods:

  • Retrospective analysis of 329 PCNL procedures.
  • Patients categorized into three groups based on access site: supracostal upper calyx, subcostal upper calyx, and non-upper calyx.
  • Preoperative imaging assessed stone burden, Hounsfield units, location, and Guy's Stone Score.

Main Results:

  • Supracostal upper calyx access (Group 1) showed higher stone-free rates (SFR) than non-upper calyx access (Group 3) (89.9% vs. 79.4%, P=.038), particularly for larger stones and higher BMI.
  • Group 1 had a significantly higher complication rate (P=.001), including hydrothorax.
  • No significant difference in complications was observed between subcostal upper calyx (Group 2) and non-upper calyx (Group 3) access.

Conclusions:

  • Upper pole access, particularly subcostal, is a safe and effective approach for PCNL.
  • Supracostal upper pole access offers higher stone-free rates for complex kidney stones but necessitates careful monitoring for hydrothorax.
  • Risk factors for chest tube insertion in supracostal access include non-left-sided PCNL and BMI < 30.