Upper pole calyx fornix subapical puncture in percutaneous nephrolithotomy

Abstract

Background

This study aims to evaluate the effectiveness of upper pole calyx fornix subapical puncture in percutaneous nephrolithotomy (PCNL) compared to traditional middle calyx puncture. The subapical puncture technique offers the advantages of upper pole access while minimizing the risk of pleural injury.

Methods

We conducted a retrospective analysis of 194 patients who underwent PCNL at our hospital from May 2022 to November 2023. Patients were divided into two groups based on puncture technique: the Upper-PCNL group (n = 122) with upper pole calyx fornix subapical puncture and the Mid-PCNL group (n = 72) with middle calyx fornix apex puncture. Data collected included tract establishment time, operative time, stone-free rates, complications, and auxiliary procedures.

Results

The Upper-PCNL group demonstrated significantly higher primary stone-free rates (83.6% vs. 69.4%, P = 0.021) and shorter operative times (59.99 ± 5.85 min vs. 68.49 ± 6.74 min, P < 0.001) compared to the Mid-PCNL group. Tract establishment time was also significantly shorter in the Upper-PCNL group (3.06 ± 0.35 min vs. 3.56 ± 0.66 min, P < 0.001). The hemoglobin drop was not significantly different between the groups. Complication rates were minimal and similar between groups. None of the patients in the Upper-PCNL group experienced pleural, liver, or spleen injuries.

Conclusions

Upper pole calyx fornix subapical puncture achieved higher stone-free rates and shorter operative times compared to middle calyx puncture, with comparable safety profiles. Prospective trials are needed to validate these findings.