Percutaneous Nephrolithotomy Puncture and Tract Dilation: Evidence on the Safety of Approaches to the Infundibulum of the Middle Renal Calyx

Kallidonis, Panagiotis; Kalogeropoulou, Christina; Kyriazis, Iason; Apostolopoulos, Dimitrios; Kitrou, Panagiotis; Kotsiris, Dimitrios; Ntasiotis, Panteleeimon; Liatsikos, Evangelos

doi:10.1016/j.urology.2017.05.038

Cited by 22 publications

(8 citation statements)

References 13 publications

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“…Kallidonis et al published a prospective randomized trial that compared papillary vs non-papillary access in PCNL, and they found that access to infundibulum is the feasible and safe procedure and it is not associated with higher blood loss and transfusion rate (7). Kallidonis et al evaluated infundibulum of the middle calyx approach technique by 99mTc-dimercaptosuccinic acid SPECT/CT renal scintigraphies and/or computerized tomographies perfusion (CTP); they found that the punctures to the mid calyceal papilla fornix and infundibulum as well as pelvis have similar angles of approach and that effects on parenchyma involved in the tract dilation are similar (8). They concluded that infundibular puncture can be an option to puncture in the performance of PCNL.…”

Section: Discussionmentioning

confidence: 99%

Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

Tahra

Sobay

Bindayı³

et al. 2020

Arch Ital Urol Androl

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Objective: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Recent literature suggests that papillary access to renal calyx is the accepted method. Despite this rule, we do not always make papillary puncture and we puncture wherever we can to achieve stone-free status and reduce unnecessary access. In this study, we present our results with papillary vs non-papillary access in patients with a kidney stone. Material and methods: Two hundred and seven patients with non-papillary access and 69 patients with papillary access who had similar demographics (age, body mass index (BMI), stone size) were selected with pair match analysis (3:1). Preoperative and postoperative data were collected from the patient's chart. Operative time (from starting surgery to nephrostomy tube), drop-in hematocrit level, transfusion rate, duration of hospital stay, perioperative and postoperative complications (Clavien-Dindo Classification) and stone-free status (no or < 3 mm residual stone) were also evaluated in both groups. Results: The mean operative time was similar in between two groups. The mean hematocrit decreases not differ between the two groups (p = 0.56). In papillary group, only 2 patients (3.2%) required transfusion and only one patient (1.4%) in the non-papillary group had a transfusion with no statistically significant difference (p = 0.43). The overall complication rates were 7.1% in the papillary group and 7.2% in the non-papillary group (p = 0.89). Postoperative mean creatinine level was similar between the two groups. Conclusions: In this study, we found that non-papillary access is a feasible option for PCNL in the terms of stone-free status and complication rates.

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Section: Discussionmentioning

confidence: 99%

Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

Tahra

Sobay

Bindayı³

et al. 2020

Arch Ital Urol Androl

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“…The authors' radiological studies demonstrated that the punctures to the infundibula and renal pelvises had a similar area of approach compared to the punctures to mid-calyceal fornices. 10 The authors acknowledge the criticism that the non-papillary approach is not the standard technique and more research in this field is required. Nevertheless, considering the reported results and aforementioned benefits of non-papillary puncture, the authors can propose it as a safe and effective approach for PCNL tract establishment.…”

Section: Authorsmentioning

confidence: 99%

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

2021

Self Cite

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Percutaneous nephrolithotomy (PCNL) is the ‘gold standard’ treatment modality for renal stones larger than 2 cm. It can be also applied to manage smaller renal stones and large, impacted stones located in the proximal ureter. Nevertheless, even in experienced hands, the PCNL procedure is associated with the development of several complications. Despite the existing extensive research in this field, studies evaluating the effect of puncture site on perioperative bleeding are very few. In part, this can be explained by the dogma that the safest way to perform kidney puncture is through the renal papilla. In this paper, the authors summarise their experience of non-papillary PCNL and demonstrate this puncture technique for PCNL tract establishment.

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“…This concept of puncturing the posterior calyx to avoid a major vascular injury has recently been questioned by studies by Kallidonis et al [15] They found an infundibular puncture safe, especially for the midpole. However, till date, this has been a single-center study which has still not found widespread acceptance among urologists.…”

Section: Which Calyx To Puncture?mentioning

confidence: 99%

Techniques for fluoroscopy-guided percutaneous renal access: An analytical review

Sharma¹,

Luitel

2019

Indian J Urol

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Percutaneous renal access is a key step for a successful percutaneous nephrolithotomy. It involves the use of fluoroscopy, ultrasonography, or a combination of both. Over the years, various techniques have been proposed for fluoroscopy-guided access, and this article reviews the different techniques along with the anatomical principles for fluoroscopy-guided percutaneous renal access. A literature search was performed using “PubMed” for relevant literature describing the various techniques for fluoroscopy-guided percutaneous renal access. Each technique was analyzed in regard to how it describes selecting the skin site for puncture and determines the angle and depth of puncture. The advantages, limitations, and variations of these techniques were also studied. Each technique has its advantages and limitations. No study has compared all the techniques either in vivo or in vitro. Only a comparative study would establish the superiority of one technique over the other. Until this is done, endourologists should be well versed with the existing techniques.

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Percutaneous Nephrolithotomy Puncture and Tract Dilation: Evidence on the Safety of Approaches to the Infundibulum of the Middle Renal Calyx

Cited by 22 publications

References 13 publications

Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

Techniques for fluoroscopy-guided percutaneous renal access: An analytical review

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