Comparative morbidity for different accesses in percutaneous nephrolithotripsy

Background: Over the last decades percutaneous nephrolithotripsy (PCNL) has been developed as an alternative for open renal operations in the treatment of complex renal stones. Currently, different approaches are used for the collecting system. Objectives: To estimate the overall morbidity of different approaches to the collecting system during PCNL to compare the complication rates for PCNL through the upper pole of the kidney with lower pole access and multiple access approaches. Methods: We retrospectively reviewed 174 patients (178 renal units) who underwent PCNL. They formed three groups according to surgical access: upper pole (n=107), lower pole (n=51) and multiple (n=20). Inter-group data on procedure - related complications were compared. Results: Postoperative fever was more frequent in the upper pole group (34%) compared to the other two groups (25% each, p<0.49). There was a higher rate of pulmonary complications in the upper pole and multiple access groups (21% and 20%, respectively) compared with the lower pole group (2%, p=0.007). The rate of bleeding and need for blood transfusion was significantly higher in the multiple access group than in the other groups (20% vs 5% and 6%, respectively, p<0.05). Conclusions: The upper and multiple access approaches were associated with a higher overall incidence of pleural effusion compared with the lower pole access. The incidence of bleeding and transfusion rates were similar using the upper and lower pole accesses but higher in the multiple access group. Provision of an enhanced surgical field and greater maneuverability together with the treatable nature of the associated complications favor an upper pole access, especially for removing a large stone burden.