Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and/or lower calyceal renal calculi- a prospective observational comparative study

Abstract

Objective To compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones. Methods Consecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm. Allocation of treatment access was based on the surgeon's preference. Variables studied included stone free rate, operating time, intraoperative and postoperative complications. Statistical analysis was executed using SPSS, Version 16.0. The statistical significance was evaluated at 5% level of significance (p value < 0.05). Results Between July 2018 and February 2019, 63 patients were included in each group. The percutaneous inserted guidewire entered the ureter in 92% in group1 and 74.6% in group 2 (p = 0.034). Stone fragments migrated to the middle calyx in 3.2% in group1 and 9.5% in group 2 (p = 0.033). A second puncture was required in one patient in group 1 and in 5 patients in group 2 (p = 0.04). The operative duration (minutes) was 13.46 ± 1.09 in the group 1 while 16.58 ± 1.44 in the group 2 (p = 0.002). Thoracic complications (hydropneumothorax) occurred to 2 patients in superior calyceal access group managed with intercostal tube drainage (p = 0.243).Post operatively blood transfusion was required in two patients in group 2 (p = 0.169). Angioembolization was done in one patient among the inferior calyceal access approach (p = 0.683). Complete stone clearance assessed at 3 months was 96.8% in group 1 and 85.7% in group 2 (p = 0.046). Conclusions Superior calyceal access is a safe and most efficacious in terms of achieving complete stone clearance rate with reduced operative time, minimal blood loss, less need for a second puncture and auxiliary procedures at minimal complications. Study registration Clinical trials registry-INDIA; CTRI/2018/07/014,687.

Superior calyceal access vs. other calyceal access in percutaneous nephrolithotomy: A systematic review and meta-analysis

“…The common PCNL approach served as the foundation for nearly all of the included investigations. Only one employed both conventional and mini PCNL methods ( 5 ). Two studies applied for both the prone and supine postures, and 11 research studies applied for the prone position only.…”

“…In this meta-analysis, since many included studies did not report the first puncture success rate, we used additional puncture as another efficacy outcome for data pooling. Five studies offered relative information comprising 597 patients who received superior calyceal access and 390 patients who received other calyceal access ( 4 , 5 , 7 , 8 , 16 ). In the overall comparison, superior calyceal access could offer a lower multiple puncture rate (OR: 0.35, 95% CI, 0.24–0.51, P < 0.001, Figure 2B ) without significant heterogeneity detected ( I 2 = 0%, P = 0.42).…”

“…After database search, 778 studies were identified. Original data from 16 research studies were extracted, and after applying screening techniques and quality assessments, they were included in the quantitative analysis (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The flowchart for screening is shown in Figure 1.…”

“…The main difference between superior and inferior calyceal access in terms of problems is that establishing the upper calyx channel frequently necessitates supracostal puncture, which may increase the risk of chest-related complications like pneumothorax and even lung injury ( 5 ). The risk of hydrothorax following supracostal puncture was minimal (3.31%), which was within an acceptable range, according to a study that was specifically focused on this procedure ( 22 ).…”

“…Superior calyceal access had a higher stone clearance rate and a similar postoperative complication rate while treating lower calyx and renal pelvis stones in this randomized controlled trial (RCT) compared to inferior calyceal access. With the exception of the RCT and representative large-sample multicenter prospective cohort study (PCS), many other published studies’ conclusions are inconsistent ( 5 , 6 ). We conducted this meta-analysis to combine and examine published data in order to produce a greater degree of evidence due to the inconsistency of earlier studies on this subject.…”