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Upper-pole access for PCNL in partial or complete staghorn calculi: Evaluation of effectiveness and safety in a contemporary series
5th Meeting of the EAU Section of Uro-Technology (ESUT), 8-10 July 2016, Athens, Greece
Saturday, 9 July Abstract session: 14.35 – 16.35 Abstract numbers O44 – O61
O44 Upper-pole access for PCNL in partial or complete staghorn calculi: Evaluation of effectiveness and safety in a contemporary series Davidoff K.M., Popov E., Roglev V.T., Popov A.A., Zlatanov D., Stoyanov N. Tokuda Hospital, Dept. of Urology, Sofia, Bulgaria INTRODUCTION & OBJECTIVES: The aim of our study is to evaluate the effectiveness and safety of PCNL with upper-pole access in cases of significant stone burden. The main advantage of the upper-pole access is direct access to most of the intrarenal collecting system and upper ureter. Upper-pole access is associated with easier guide-wire passage due to the alignment of puncture and renal axis. This fact allows for improved visualization of collecting system with rigid instruments and is less traumatic for the kidney compared to lower pole access because of decreased manipulation. Because of the anatomical relations of the kidneys, the upper pole access, especially when performed via supracostal approach, is associated with a higher rate of pulmonary complications. MATERIAL & METHODS: In the period 6.2013 – 12.2015 349 PCNL procedures were performed in our institution. In 217 patients (61,3 %) percutaneous nephrolithotomy (PCNL) was performed through the upper pole (group I) and in 132 patients (37,8%) PCNL were performed via lower pole or middle calyx approach (group II). In both groups, PCNL was done by the standard technique with access achieved under fluoroscopic control. The stone burden, success rate, and complications in the two groups were compared. RESULTS: Patients were stone free in 84.3% and 76,2% of the cases in groups I and II, respectively, but this difference in success rate becomes statistically significant when only the sub-group of patients with complete or partial staghorn calculi was analyzed – 78,3 % stone free rate in group I and 55,3 % stone free rate in group II, respectively. There was no statistically significant difference between the two groups regarding operating time and septic and hemorrhagic complications. Clinically significant hydrothorax was found in 8 patients (5.06%) of group I and necessitates thoracic drainage. In one of this patients (0,4 %) hemothorax was observed which needed surgical revision. No pulmonary complications were observed in group II. CONCLUSIONS: PCNL through upper pole access is highly effective in cases of significant stone burden, with higher stone-free rates compared with lower-pole access, with acceptable complications rate. The measures for decreasing the possibility for pulmonary complications makes this technique even safer – use of subcostal approach for upper-pole access, puncture in state of inspiration, caudal displacement of the kidney with second needle.
European Urology Supplements 15(6), 2016
178
Saturday, 9 July Abstract session: 14.35 – 16.35 Abstract numbers O44 – O61
O44 Upper-pole access for PCNL in partial or complete staghorn calculi: Evaluation of effectiveness and safety in a contemporary series Davidoff K.M., Popov E., Roglev V.T., Popov A.A., Zlatanov D., Stoyanov N. Tokuda Hospital, Dept. of Urology, Sofia, Bulgaria INTRODUCTION & OBJECTIVES: The aim of our study is to evaluate the effectiveness and safety of PCNL with upper-pole access in cases of significant stone burden. The main advantage of the upper-pole access is direct access to most of the intrarenal collecting system and upper ureter. Upper-pole access is associated with easier guide-wire passage due to the alignment of puncture and renal axis. This fact allows for improved visualization of collecting system with rigid instruments and is less traumatic for the kidney compared to lower pole access because of decreased manipulation. Because of the anatomical relations of the kidneys, the upper pole access, especially when performed via supracostal approach, is associated with a higher rate of pulmonary complications. MATERIAL & METHODS: In the period 6.2013 – 12.2015 349 PCNL procedures were performed in our institution. In 217 patients (61,3 %) percutaneous nephrolithotomy (PCNL) was performed through the upper pole (group I) and in 132 patients (37,8%) PCNL were performed via lower pole or middle calyx approach (group II). In both groups, PCNL was done by the standard technique with access achieved under fluoroscopic control. The stone burden, success rate, and complications in the two groups were compared. RESULTS: Patients were stone free in 84.3% and 76,2% of the cases in groups I and II, respectively, but this difference in success rate becomes statistically significant when only the sub-group of patients with complete or partial staghorn calculi was analyzed – 78,3 % stone free rate in group I and 55,3 % stone free rate in group II, respectively. There was no statistically significant difference between the two groups regarding operating time and septic and hemorrhagic complications. Clinically significant hydrothorax was found in 8 patients (5.06%) of group I and necessitates thoracic drainage. In one of this patients (0,4 %) hemothorax was observed which needed surgical revision. No pulmonary complications were observed in group II. CONCLUSIONS: PCNL through upper pole access is highly effective in cases of significant stone burden, with higher stone-free rates compared with lower-pole access, with acceptable complications rate. The measures for decreasing the possibility for pulmonary complications makes this technique even safer – use of subcostal approach for upper-pole access, puncture in state of inspiration, caudal displacement of the kidney with second needle.
European Urology Supplements 15(6), 2016
178