Is Upper Pole Puncture for Percutaneous Nephrolithotomy (PCNL) Safe and Effective?

Abstract

Introduction: During this modern era of surgery, where miniaturization has taken a front row seat, endo-urology is flourishing like never before. PCNL has become the chosen tool for treating Staghorn stones, large renal calculi and complex upper ureteric calculi. The renal collecting system can be accessed by upper or lower pole puncture. Lower pole access is considered safer with fewer complications; however the benefits of upper pole access for PCNL also stands tall due to direct access to the most of renal calyxes system, renal pelvis and upper ureter. A lot of debate and confusion is recorded worldwide with respect to both methods. Aims & Objectives: To determine the outcome of upper pole access for removal of renal stones in patients undergoing Percutaneous Nephrolithotomy. Place and duration of study: A descriptive study, conducted in Department of Urology, SIMS/SHL, in 2 year period i.e. 1-02-2018 to 31-01-2020. Material & Methods: A Total of 62 patients fulfilling selection criteria were included in the study. All of these cases were operated under general anesthesia. Post-operatively, patients X-ray K.U.B were performed for presence or absence of stone. If there was no stone found in x-ray, then efficacy was labeled as high. Regarding complications, patients were evaluated for presence of hydrothorax and bleeding. If there was no complication, then safety was labeled as adequate. All this information was recorded on proforma. Results: The mean age of patients was 32.58±9.41 years. There were 29 (46.8%) males and 33 (53.2%) females. The mean size of stone was 2.50±0.50mm. In this study, 20 (32.3%) patients had one stone, 25 (40.3%) had two stones and 17 (27.4%) had three stones. High Efficacy of PCNL was achieved in 50 (80.6%) patients while PCNL was adequately safe in 45 (72.6%) cases while 17 (27.4%) patients had complications. Conclusion: This study showed that PCNL with upper pole approach was found to be highly effective in renal stone removal and is also safe in more than 70 % of cases.