Comparative Study of Outcome of Upper Pole Versus Non-Upper Pole Single Puncture Percutaneous Nephrolithotomy for Staghorn Stones

Abstract

Percutaneous Nephrolithotomy (PCNL) is the treatment of choice for staghorn renal stones, either with an upper-pole (UP) or non-upper (lower or middle) pole (NUP) approach. Various studies have been sought to compare the outcomes of UP and NUP approach although results have not been entirely consistent. Hence, this study was designed to compare the outcome of two different renal access techniques on the stone-free rate of single puncture percutaneous nephrolithotomy. This Quasi-experimental study was conducted at the Department of Urology, Dhaka medical college Hospital, for a period of one year from January 2021 to December 2021. A total of 44 renal staghorn stone cases who underwent PCNL were included as study patients and were divided into two groups. Group-A (PCNL with UP calyceal approach) and Group-B (PCNL with NUP-middle or lower calyceal approach). Informed written consent was taken from each participant for operative procedure. Each patient was subjected to detail clinical evaluation along with history taking. Stone clearance was assessed by X-Ray KUB. Re-treatment if required for residual stones were done after 4 weeks. D-J stent was removed 4 weeks later. Collected data were analyzed by using the statistical software SPSS 24. The majority of the study participants from both the groups were from 45-54 years age (63.6% of Group A and 54.5% of Group B). There were no significant differences between groups in terms of demographic characteristics (age, sex, size of stone). The mean operation time was 73.45±6.52 (SD) minutes for the Group A and 76.05±5.18 (SD) minutes for Group B patients (p>0.05). The mean post-operative hemoglobin drop was 1.27±0.70 (SD) gm/dl for Group A and 1.32±0.47 (SD) gm/dl for Group B patients (p>0.05). Post-operative fever were developed in 22.7% Group A and 31.8% Group B patients (p>0.05). Complete stone clearance was achieved in 77.3% of Group A and 63.6% of Group B patients (p>0.05). Retreatment required for complete stone clearance after PCNL were 22.7% of Group A patients and 36.4% of Group B patients. Retreatment rate was higher in Group B patients but there wasn’t any statistically significant difference between groups when compared (p>0.05). Percutaneous Nephrolithotomy for staghorn stones with single Upper pole access has similar stone free rate and complication rates compared to single non-upper polar approach.