Comparative Evaluation of Upper Pole and Non-Upper Pole Puncture Techniques in Percutaneous Nephrolithotomy (PCNL): A Retrospective Analysis of Efficacy and Safety Parameters

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is a critical intervention in the management of large renal calculi, with the choice of calyx puncture technique impacting the efficacy and safety of the procedure. While the upper pole approach is associated with better visualization and stone clearance, it is used with caution due to a perceived increase in complication rates. Objective: This study aimed to compare the upper pole calyx puncture technique's efficacy and safety with that of the non-upper pole (middle and lower) puncture techniques in PCNL. Methods: A retrospective analysis was conducted on 173 patients who underwent PCNL at the Urology and Transplant Unit A of The Institute of Kidney Diseases in Peshawar from January 2017 to December 2020. Data on demographics, stone characteristics, perioperative findings, and postoperative outcomes were collected. Statistical significance was determined using Chi-square tests with SPSS version 25. Results: The average stone size was 21.38 mm (±11.2 mm) overall, with the upper pole group presenting a smaller average size of 19.8 mm (±7.6 mm) compared to 21.55 mm (±10.8 mm) for the non-upper pole group (p=0.032). Pre-operative hemoglobin levels were slightly lower in the upper pole group (12.5 ± 1.8 mg/dl) than in the non-upper pole group (12.9 ± 1.8 mg/dl, p=0.007). Complete clearance rates were comparable between groups. Post-operative blood transfusion was required more frequently in the non-upper pole group (12.1%, n=12) versus the upper pole group (4.0%, n=3, p=0.04). Conclusion: The upper pole approach in PCNL may afford a higher rate of stone clearance and reduced operative times with acceptable safety when compared to non-upper pole approaches. The selection of puncture technique should be tailored to individual patient anatomy and stone characteristics, with consideration given to the surgeon's experience and skill.