Login to Access Video or Poster Abstract: MP50-13
Sources of Funding: None

Introduction

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for patients with staghorn calculi. Opinions tend to vary whether an upper pole (UP) versus lower pole (LP) approach offers the best access. The literature suggests an UP approach is more favorable due to higher stone-free rates (SFR), however this access carries a higher risk of bleeding and pleural injury. We developed a modified LP (more medial and inferior puncture angle) to allow single tract staghorn removal with better stone free rates while minimizing thoracic complications and compared this technique to primary UP access PCNL outcomes for staghorn stones._x000D_

Methods

In this IRB approved retrospective analysis, 79 out of 473 patients had PCNL for staghorn calculi. 58/79 underwent our modified LP access technique and 21 patients had primary UP (17) or interopolar (4) access. Outcomes assessed included stone free rate (SFR), and number of punctures, EBL, OR time, and intra- and post-op complications._x000D_

Results

A total of 58/79 (73%) patients received initial LP access using our modified technique. Of these 58 patients, 45 (78%) needed only a single tract, while 13 needed multiple accesses. In patients having primary UP access, 13/17 (76%) required only a single tract (no statistical difference). SFR’s are in Table 1. Complication rates were 6.7% for primary single site LP access (3.5% for all LP initial punctures) vs. 23.1% for primary single site UP access (29.4 for all UP initial punctures) (p < .05). There was no statistical difference in EBL, fluoro time, LOS, stone volume, or stone density among the groups. OR time was less in the single tract LP group (113 min vs. 148 min, p=0.006). There were 2 pulmonary complications in the UP group, with none in LP group; Table 1._x000D_

Conclusions

Our modified LP access technique was feasible in 73% (58/79) of staghorn patients without increasing the need for multiple tracts compared to primary UP access. Complication rates were lower and SFR rates higher for our modified technique, which will be described in detail. _x000D_

Funding

None