Safety and efficacy of the upper calyceal approach during percutaneous nephrolithotomy at the Hospital Central Militar

Abstract

Background: Renal access through the upper pole for percutaneous nephrolithotomy (pnl) is often avoided due to a higher complication rate. Said access can achieve higher stone-free rates with similar complication rates. We evaluated the safety and efficacy of renal access through the upper pole for pnl at our hospital center.

Materials and methods: A retrospective analysis was carried out that included all pnls performed between June 2017 and October 2018 at our hospital. The inclusion criteria were patients in whom the urologist obtained renal access through the upper pole for pnl. Stone-free status was determined by means of abdominal x-ray or computed tomography on postoperative day one. Patients were considered stone-free when no stones were visible in the abdominal x-ray or when stones were smaller than 4 mm in the computed tomography scan. 

Results: Renal access through the upper pole for pnl was achieved in 39 patients. There were 21 (53.84%) staghorn stones, 6 (15.38%) of which were classified as partial.  The kidney was accessed above the 11th rib in 12.8% (n = 5) of the patients, between the 11th and 12th rib in 48.7% (n = 19), and access was subcostal in 38.5% (n = 15). Eight (20.51%) patients presented with complications, 3 (7.7%) of whom presented with hydrothorax that required a chest tube. The postoperative images confirmed that 33 (84.61%) patients were stone-free and 6 (15.39%) needed an auxiliary procedure to resolve the stone burden.

Conclusions: Our experience with percutaneous renal access through the upper pole for nephrolithotomy has shown it to have an acceptable risk for complications, with a stone-free rate similar to that reported in the international literature, and to be superior to other access routes in the management of complex stones.