title: The best calyceal tract approach for treating renal stones with percutaneous nephrolithotomy.
abstract: OBJECTIVE
  To compare the perioperative outcomes of percutaneous nephrolithotomy (PCNL) performed via the upper middle, and lower calyces.
  
  
  METHODS
  The authors retrospectively reviewed 92 renal units in 92 patients who required PCNL at our institution between 2006 and 2010. Patients with partial and full staghorn stones with total stone size > or = 2 cm were included in the present study. Patients were excluded if they had multiple small stones or a single stone < 2 cm. The present study analyzed 92 renal units in 92 patients. The authors divided the patients into three groups (groups 1, 2, and 3) based on the surgical approach, which was the upper middle, and lower calyceal approaches. PCNL was performed using a standard ultrasonic lithotriptor with a rigid nephroscope, and holmium: YAG laser lithotripsy was carried out with a flexible nephroscope, with simultaneous nitinol tipless basket extraction of fragments. Procedures were repeated until the patients were rendered stone-free (confirmed visually or by nephrostogram). Estimated blood loss, length of hospital stay, operative time, and the number of procedures (to achieve stone-free status) were analyzed and compared among the groups, and complications were reported.
  
  
  RESULTS
  The present study showed that the length of hospital stay, estimated blood loss, number of procedures, and operative time were not significantly different between the three groups. In Group 1, four patients had complications and included two patients with mid-ureteral stone, and one patient each with renal pelvic perforation and urinary tract infection with sepsis. One patient from Group 2 contracted a urinary tract infection. In Group 3, five patients exhibited complications and included one with mid-ureteral stone, two with renal hemorrhage, and two with urinary tract infection.
  
  
  CONCLUSIONS
  The estimated blood loss, duration of hospital stay, operative time, number of procedures (to achieve stone-free status), and complications did not statistically differ between the three groups. Moreover very few complications occurred in the different surgical approaches. Therefore, PCNL via all the three approaches were deemed safe and effective.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
authors.forename: Pontape
authors.initials: P
authors.lastname: Chanprasopon
authors.forename: Wisoot
authors.initials: W
authors.lastname: Kongchareonsombat
authors.forename: Charoen
authors.initials: C
authors.lastname: Leenanupunth
authors.forename: Kittinut
authors.initials: K
authors.lastname: Kijvikai
authors.forename: Wit
authors.initials: W
authors.lastname: Viseshsindh
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D007670:Kidney Calices / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation / Q000706:statistics & numerical data; D012107:Research Design; D016896:Treatment Outcome