Is Lower Pole Access Safer for Ultrasound-Guided Supine Percutaneous Nephrolithotomy?

Ultrasound (US)-guided supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. The aim of this study was to assess the safety of lower vs non-lower pole access (non-LPa) in supine US-guided PCNL.

This study was a retrospective cohort analysis of 228 patients who underwent single-access US-guided supine PCNL between March 2023 and June 2024 and were categorized into lower (n = 162), interpolar (n = 42), and upper pole (n = 21) access categories. Baseline demographics, stone characteristics, and intraoperative details were analyzed and compared between the groups. Safety outcomes, including 30-day postoperative total and major complications (based on Clavien-Dindo classification), as well as pain scores, were compared between lower pole access (LPa) and non-LPa.

Baseline clinical and stone characteristics were comparable between the groups. Non-LPa was more frequently performed on the right side (P = .04), above the 12th rib (P < .001), into a posterior calyx (P = .004), and more often followed by stent placement (P = .01). Major complications occurred in 14% of the patients with upper pole access compared with 2% with LPa (P = .03) and 5% with interpolar. In addition, the LPa group had lower rates of total complications compared with upper pole and interpolar (11% vs 19% and 22%, respectively, P = .05). There were 2 visceral injuries in the interpolar group. Visual analogue scale pain scores at the recovery room were not different between the groups.

When performing US-guided supine PCNL, LPa has a superior safety profile, resulting in fewer major and total complications compared with non-LPa.