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Challenging the wisdom of puncture at the calyceal fornix in percutaneous nephrolithotripsy: feasibility and safety study with 137 patients operated via a non-calyceal percutaneous track

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Abstract

Objectives

To present our experience with a central, non-calyceal puncture protocol for percutaneous nephrolithotripsy (PCNL) in an attempt to challenge the opinion of worldwide adopted calyceal puncture as the less traumatic site of percutaneous entrance into the collecting system.

Patients and methods

During 2012, a total of 137 consecutive, unselected patients were subjected to PCNL in our department. Non-calyceal punctures were performed to all cases and followed by subsequent track dilations up to 30 Fr. Perioperative and postoperative data were prospectively collected and analyzed.

Results

Mean operative time (from skin puncture to nephrostomy tube placement) was 48 min. Patients with single, multiple and staghorn stones had primary stone-free rates of 89.2, 80.4 and 66.7 % after PCNL, respectively. The overall complication rate was 10.2 %, while bleeding complications were minimal. Only 4 patients (2.9 %) required blood transfusion. Five patients (3.6 %) had Clavien Grade IIIa complications requiring an intervention for their management and none Grade IV or V.

Conclusions

Despite the absence of evidence that non-calyceal percutaneous tracts could be a risk factor for complications, the concept of calyceal puncture has been worldwide adopted by PCNL surgeons as the sole safe percutaneous entrance into the collective system. Based on our experience, other pathways than the worldwide recognized rule, calyceal puncture, are possible and probably not as dangerous as has been previously stated.

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Authors’ contribution

I Kyriazis was involved in data collection, data analysis and manuscript editing; P. Kallidonis, M. Vasilas, V. Panagopoulos and W. Kamal were involved in data collection, data analysis and review of the manuscript; E. Liatsikos gave the concept of study and was involved in supervision, data analysis and review of the manuscript.

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Authors and Affiliations

  1. Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece

    Iason Kyriazis, Panagiotis Kallidonis, Marinos Vasilas, Vasilios Panagopoulos, Wissam Kamal & Evangelos Liatsikos

Authors
  1. Iason Kyriazis
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  2. Panagiotis Kallidonis
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  3. Marinos Vasilas
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  4. Vasilios Panagopoulos
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  5. Wissam Kamal
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  6. Evangelos Liatsikos
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Corresponding author

Correspondence to Iason Kyriazis.

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Conflict of interest

Authors have no conflict of interest to declare.

Ethical standard

Institutional ethical board approval had been acquired for this study. All patients had provided a signed informed consent prior to their operation including the use of their clinical data for further analysis. Patient confidentiality and anonymity was preserved throughout this clinical protocol.

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Kyriazis, I., Kallidonis, P., Vasilas, M. et al. Challenging the wisdom of puncture at the calyceal fornix in percutaneous nephrolithotripsy: feasibility and safety study with 137 patients operated via a non-calyceal percutaneous track. World J Urol 35, 795–801 (2017). https://doi.org/10.1007/s00345-016-1919-y

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  • DOI: https://doi.org/10.1007/s00345-016-1919-y

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