Impact of Anterior Kidney Calyx Involvement of Complex Stones on Outcomes for Patients Undergoing Percutaneous Nephrolithotomy

Abstract

Introduction: A number of factors that can impact the outcomes of percutaneous nephrolithotomy (PCNL) procedures have previously been investigated. Complex stones that extend to the anterior calyx could affect the success and complication rates of PCNL. Objective: We analyzed the effect of anterior calyx involvement on the outcomes of patients with complex stones treated with PCNL. Methods: A total of 132 consecutive patients who underwent PCNL due to complex stones (multiple, partial staghorn, or staghorn stones) between 2015 and 2017 were enrolled in this study. They were stratified into two groups based on whether the stone extended to the anterior calyx (group 1, n = 45) or not (group 2, n = 87). The stratification was achieved through contrast-enhanced computerized tomography (CT). Demographics, laboratory tests, and peri-and postoperative findings (operation and fluoroscopy duration, hospital stay, utilization of flexible instruments, access numbers, total blood count change, stone-free rate [SFR], and complications) were compared between the groups. The SFR was evaluated by plain kidney-ureter-bladder radiography or CT. Results: The demographics, operation and fluoroscopy duration, access number, and hospital stay were similar between the groups (p < 0.05). A higher drop in the hemoglobin level in group 1 was identified (group 1 [2.14 ± 1.49 g/dL] vs. group 2 [1.43 ± 1.31 g/dL]) (p = 0.006). The SFR among the patients with extension to the anterior calyx was 60%, compared to 77% among the patients with no extension to the anterior calyx (p = 0.041). Flexible instruments were utilized in 60% of the patients of group 1, which was a higher rate than for group 2 (36%) (p = 0.007). Complication rates were similar in the two groups according to the Clavien-Dindo classification (p > 0.05). Conclusions: Our study demonstrated that complicated stones with extension to the anterior calyx are more challenging than cases without extension to the anterior calyx. This was noted by a lower SFR, a more prominent drop in total blood count, and more frequent utilization of flexible scopes.

Clinical comparative study of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydrone

“…Meanwhile, the study results of Perepanova et al 15 suggested that excessive injury to renal parenchyma would increase the occurrence of postoperative systemic infection syndrome and urinary sepsis. It was considered in the study of Kalkanli et al 16 that complex calculi are more challenging than those confined to the renal pelvis, and lower red blood cell counts and higher infections after surgery are caused by a larger range of nephroscope swings during surgery. Despite being able to increase the calculus clearance rate, to a certain extent, via the establishment of multiple channels intraoperatively to compensate for the blind area of the main channel visual field, the injury to the kidneys can also be increased.…”

Letter to the Editor regarding the Article “Impact of Anterior Kidney Calyx Involvement of Complex Stones on Outcomes for Patients Undergoing Percutaneous Nephrolithotomy”

“…We have read the recently published article by Kalkanli et al [1] with great interest. It is an interesting study on a field that has been rarely studied in the literature.…”

“…The study by Kalkanli et al [1] would have been more informative if the authors had presented data on the localization of the residual fragments. With the given results, we only understand that SFRs are higher in patients with anterior calyx stones.…”

“…Another issue that was not discussed in the article by Kalkanli et al [1] is the initial access localization. But in this study, the initial access localization was not reported.…”

Response to the Letter to the Editor: “Impact of Anterior Kidney Calyx Involvement of Complex Stones on Outcomes for Patients Undergoing Percutaneous Nephrolithotomy”

“…Surgeons who frequently performed percutaneous nephrolithotomy (PCNL) may have experienced the difficulty of reaching anterior calyx stones. However, there are not enough studies on this subject in the literature [2-4]. We aimed to be a preliminary work in this matter with this study.…”