Safety and efficacy of a single middle calyx access (MCA) in mini-PCNL
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ORIGINAL PAPER
Safety and efficacy of a single middle calyx access (MCA) in mini‑PCNL Sanjay Khadgi1 · Ahmed R. EL‑Nahas2 · Maitrey Darrad3 · Abdullatif AL‑Terki2 Received: 24 August 2019 / Accepted: 3 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract To compare outcomes of a single middle calyx access (MCA) with a single upper or lower calyceal access in mini-PCNL. From May 2015 through August 2018, patients’ files who underwent a single renal access mini-PCNL were retrospectively reviewed. All patients underwent fluoroscopic-guided access (16–20 F) in the prone position. They were categorized into group 1 (MCA) and group 2 (either upper or lower calyceal access). Compared preoperative items included stone location, size, number and complexity (according to Guy’s score). The compared outcome parameters were complication and stone-free rates. The study comprised 512 consecutive patients, 374 patients in group 1 and 138 in group 2. A single MCA was utilized to access 95% of proximal ureteral calculi, 89% for ureteropelvic junction stones, and 84% for stones present in the pelvicalyceal system and ureter. MCA was used in 89% of complete staghorn stones and 73% of multiple stones. the Stone-free rates (93% vs 90.6%, P = 0.350) and the complications rates (8% vs 7.2%, P = 0.772) were comparable between group 1 and 2 despite that MCA was used for most cases with complex stones. Complications severity were also comparable (P = 0.579). Mini-PCNL performed through a single MCA is effective and safe. This access can be used for the treatment of renal and upper ureteral calculi of different complexities and locations. Keywords Mini-PCNL · Mini-PERC · Middle calyx · Renal stones
Introduction Percutaneous nephrolithotomy (PCNL) is the recommended treatment of large, multiple and complex renal stones [2, 3]. It had the highest single-treatment stone-free rate (SFR) when compared with other treatment modalities for renal stones such as extracorporeal shockwaves lithotripsy (SWL) [4] and flexible ureteroscopy (F-URS) [5]. The main drawback of PCNL is the higher rates and severity of complication than other treatment options [6]. Percutaneous tract size was reported to be a significant factor in bleeding that necessitated blood transfusion [7] This abstract was presented in Urofair conference in Singapore 4–6 April 2019 [1]. * Ahmed R. EL‑Nahas [email protected] 1
Department of Urology, Vayodha Hospital, Kathmandu, Nepal
2
Urology Unit, AL-Amiri Hospital, Gulf road, Sharq, Kuwait, Kuwait
3
Department of Urology, University Hospital Birmingham NHS Foundation, Birmingham, UK
and in blood loss after PCNL [8]. Therefore, the size of percutaneous tract was minimized from the standard PCNL of 26–30 French (F) to
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