Login to Access Video or Poster Abstract: MP68-18
Sources of Funding: none

Introduction

The ideal puncture provides the shortest and straightest access to all calculi, avoids major vessels, bowel and lung, follows the axis of the calyx, causes minimal parenchymal damage and is bloodless. It is well accepted that best way to access the pelvicalyceal system is through the tip of the papilla. We describe the ‘split papilla’ which provides endoscopic evidence of a correct puncture. _x000D_ _x000D_ The objective was to study the hemoglobin fall and blood transfusion rate between split papilla group versus non split papilla group.

Methods

_x000D_ All punctures were done by using the triangulation technique using fluoroscopy. Tracts were dilated using a balloon dilator. Once the stone was cleared the Amplatz was withdrawn into the tract to visualize the split papilla. Which appeared as triangular flaps with straight lines converging towards the apex. We compared endoscopic time, drop in hemoglobin and transfusion rate in those patients in whom the split papilla( Group A) was demonstrable versus those in whom it was not( Group B). _x000D_

Results

During the study period 123 patients underwent PCNL. 45 patients did not have split papilla, 78 patents had split papilla. All the parameters were matched in both groups. The average fall in hemoglobin in Group A was 1.4 (SD1.06) and in group B was 2.2( SD 0.9), p-value 0.001. None required blood transfusion in both the group.

Conclusions

Blood loss was significantly lesser in patients where a split papilla could be demonstrated. A careful search for this finding can provide the surgeon with a quality control tool to assess the PCNL puncture.

Funding

none