title: Impact of percutaneous access point number and location on complication and success rates in percutaneous nephrolithotomy.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PNL) is sometimes associated with complications, especially in patients with complex stones. Herein, we review our experience with PNL to determine the impact of percutaneous access number and location on success and complication rates.
  
  
  METHODS
  During a 2-year period, a total of 275 patients with a mean age of 42.3 +/- 14.8 (range: 13-75) years underwent PNL. Stones were classified as simple in 51.6%, and complex (staghorn calculi or renal pelvis stones coexisting with caliceal stones) in 48.4%. Percutaneous access was done under C-armed fluoroscopy and the tract was formed with a high-pressure balloon dilation system. One single percutaneous access was sufficient in 210 (76.4%), while 2 accesses were utilized in 44 (16%), and > or =3 accesses in 21 cases (7.6%). Supracostal access was performed in 23 (8.4%) patients.
  
  
  RESULTS
  An overall success rate of 94.9% was achieved. Stone location, but not the access point location, was the major determinant for success, which was 99.3 and 90.2% in patients with simple and complex stones, respectively (p < 0.01). Significant complications included bleeding necessitating blood transfusion in 28 (10.2%), and hydropneumothorax in 2 (0.7%) patients. Bleeding was observed in 39.1 and 7.5% of patients managed with supracostal access, and subcostal access, respectively (p < 0.01). An increased number of access points significantly augmented the risk for bleeding. Bleeding was encountered in 7.6% of patients managed with 1 percutaneous access point, and in 18.5% of cases managed with > or =2 access points (p < 0.05). Hydropneumothorax occurred in patients with supracostal access.
  
  
  CONCLUSIONS
  Supracostal access as well as multiple punctures may be needed especially in the management of complex stones, and the need for multiple access points and supracostal access significantly increases complication rates.
authors.affiliation: Department of Urology, Haseki Teaching and Research Hospital, Haseki, Istanbul, Turkey.
authors.forename: Ahmet Yaser
authors.initials: AY
authors.lastname: Muslumanoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tefekli
authors.forename: Mert Ali
authors.initials: MA
authors.lastname: Karadag
authors.forename: Adem
authors.initials: A
authors.lastname: Tok
authors.forename: Erhan
authors.initials: E
authors.lastname: Sari
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Berberoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016896:Treatment Outcome