Comparative Study of Complications of Single-Tract versus Multi-Tract Percutaneous Nephrolithotomy Using the Modified...

Percutaneous nephrolithotomy (PCNL) is a minimally invasive and often safe and well-tolerated procedure. Studies with the standardized evaluation of complications of PCNL comparing single-tract and multi-tract PCNL are scarce. This study was conducted on this knowledge gap. An observational follow-up study among purposively selected 50 patients diagnosed with renal calculi undergoing PCNL was conducted in the Department of Urology, Dhaka Medical College Hospital, Bangladesh from April 2021 to December 2021. All complications were documented and classified according to the modified Clavien system. Twenty eight (28) subjects underwent single-tract and 22 underwent multi-tract PCNL; all were male and the mean ages were similar in the two groups (44.35±11.4 vs. 44.1±16.2 years). Right-side stones were more frequent (71.4%) in the single-tract group and left-side stones were more frequent (59.1%) in the multi-tract group. Stone size was larger in the multi-tract group than in the single-tract group (5.0±0.5 vs. 3.3±0.4 cm, p=0.012). Although grade I complications (54.5% vs. 32.1%, p=0.111) and grade II complications (100.0% vs. 64.3%, p=0.007) were more frequent in the multi-tract group than in the single-tract group, the single-tract group had a higher frequency of grade III (53.6% vs. 45.5%, p=0.569) and grade IV (21.4% vs. 9.1%, p=0.238); there were no grade V complications in either group. As a whole, complications were more frequent in the multi-tract than in the single-tract group (100.0% vs. 71.4%, p=0.024) and most were of lower grades (grade I and grade II) which were possible to manage conservatively. Grade III and grade IV complications were most frequently observed in the single-tract PCNL that required further intervention or management in the intensive care unit. Multi-tract PCNL is associated with higher lower-grade complications that can be managed conservatively. In contrast, higher-grade complications that need intervention or intensive care unit management are more frequent in single-tract PCNL. So, multi-tract PCNL is effective with acceptable morbidity in selected cases of large renal stones.