V6-08 LARGE UPPER-CALYX STONE: CAN SUPRA-TWELFTH PCNL APPROACH BE AVOIDED?

Abstract

You have accessJournal of UrologyUrolithiasis1 Apr 2015V6-08 LARGE UPPER-CALYX STONE: CAN SUPRA-TWELFTH PCNL APPROACH BE AVOIDED? Jose Agudelo, Euro Arias, Nasser Ktech, Jhonan Chirinos, Manuel Riveros, Luis Sanchez, Eduardo Pena, and Ricardo Montiel Jose AgudeloJose Agudelo More articles by this author , Euro AriasEuro Arias More articles by this author , Nasser KtechNasser Ktech More articles by this author , Jhonan ChirinosJhonan Chirinos More articles by this author , Manuel RiverosManuel Riveros More articles by this author , Luis SanchezLuis Sanchez More articles by this author , Eduardo PenaEduardo Pena More articles by this author , and Ricardo MontielRicardo Montiel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.473AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A large renal stone is considered any calculi larger than 2 cm. When this burden is located in the upper calyx, a supracostal PCNL approach has to be considered. However, many urologists hesitate to use this access because of the potential for intrathoracic complications. As a result, other techniques to avoid the supracostal approach and access the upper pole have been described. Most of them required staged or auxiliary procedures. We present our series of large upper calyx stone, and we will evaluate if it is a good option to avoid a supracostal approach in terms of efficacy. METHODS We will illustrate in the videotape, the decision process in the treatment of a large upper calyx stone. We have applied this evaluation to 22 consecutive patients with a mean stone burden of 3529 mm3. We outlined the method with a 48 years old male and a large upper calyx stone burden. After evaluating all the endourological alternatives to treat a stone with this feature, we decided to offer him a supracostal PCNL approach. Following informed consent, the patient was placed prone after an open end ureteral catheter was introduced. A supra twelfth rib puncture was accomplished, and sequential metal dilation was done. It was followed by insertion of a 24 french amplatz sheath. A direct access to the stone was observed. Initially, laser lithotripsy was applied for debulking the stone. It was followed by ultrasonic lithotripsy, and removal of the fragments. A nephrostomy tube was placed at the end of the surgery. RESULTS Supracostal access was performed in all 22 patients in this series. Mean operating time was 74.4 minutes. A high stone clearance of 86.3% was achieved. Not major complications were observed. There were just two pleural effusions demonstrated on posoperative X rays, that did not require interventions. CONCLUSIONS The concern for potential morbidity associated with supracostal punctures, precludes many endourologists from performing these approaches. In some cases like large upper calyx stones, the supracostal access is the most effective option, and the surgeon has to be prepared to offer this procedure within a safe margin. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e579 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Agudelo More articles by this author Euro Arias More articles by this author Nasser Ktech More articles by this author Jhonan Chirinos More articles by this author Manuel Riveros More articles by this author Luis Sanchez More articles by this author Eduardo Pena More articles by this author Ricardo Montiel More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...