Is Lower Pole Access Safer for Ultrasound-Guided Supine Percutaneous Nephrolithotomy?
Academic Article
Overview
abstract
INTRODUCTION: Ultrasound (US) guided supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. The aim of this study is to assess the safety and efficacy of lower versus non-lower pole access in supine US-guided PCNL. METHODS: This study is a retrospective cohort analysis of 228 patients who underwent single access US-guided supine PCNL between March 2023 and June 2024 and were categorized into lower (n=162), interpolar (n=42) and upper pole (n=21) access categories. Baseline demographics, stone characteristics and intraoperative details were analyzed and compared between the groups. Safety outcomes, including 30-day postoperative total and major complications (based on Clavien-Dindo classification), as well as pain scores, were compared between lower pole access (LPa) and non-LPa access. RESULTS: Baseline clinical and stone characteristics were comparable between the groups. Non-LPa was more frequently performed on the right side (p=0.04), above 12th rib (p<0.001), into a posterior calyx (p=0.004), and more often followed by stent placement (p=0.01). Major complications occurred in 14% of the patients with upper pole access compared to 2% with LPa (p=0.03) and 5% with interpolar. Additionally, the LPa group had lower rates of total complications compared to upper pole and interpolar (11% vs 19% and 22% respectively, p=0.05). There were two visceral injuries in the interpolar group. VAS pain scores at the recovery room were not different between the groups. CONCLUSION: When performing US-guided supine PCNL, LPa has a superior safety profile, resulting in fewer major and total complications compared to non-LPa.
