Access to the upper calyx in supine position: breaking a myth

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Upper calyx access in supine percutaneous nephrolithotomy (PCNL) remains controversial regarding its feasibility and safety.
• Percutaneous nephrolithotomy is a key procedure for managing large renal and proximal ureteral stones.

Purpose of the Study:

• To detail the technique for upper calyx access in supine PCNL.
• To evaluate the effectiveness and safety outcomes in a large patient cohort.

Main Methods:

• 100 patients with renal and proximal ureteral stones underwent supine PCNL with upper calyx access (2013-2023).
• Access was guided by ultrasound (US) and fluoroscopy in the Galdakao-modified supine Valdivia position.
• Stone-free rate (SFR) assessed by non-contrast CT scan (NCCT); complications graded using PCNL-specific Clavien-Dindo score.

Main Results:

• A single-procedure stone-free rate (SFR) of 85% was achieved.
• No intraoperative complications occurred; 27 postoperative complications were reported (8% Grade I, 14% Grade II, 5% Grade III).
• No significant thoracic, liver, or spleen injuries were observed; median hospital stay was 3 days.

Conclusions:

• Ultrasound and fluoroscopy-guided upper calyx access in supine PCNL is a feasible and safe technique.
• This approach offers a low complication rate and a high stone-free rate for treating kidney and proximal ureteral stones.