title: Comparative evaluation of upper versus lower calyceal approach in percutaneous nephrolithotomy for managing complex renal calculi.
abstract: BACKGROUND
  Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn and large renal stones. The success of PCNL is highly related to optimal renal access. Upper calyceal puncture being more difficult and more demanding have relatively few studies presented.
  
  
  OBJECTIVE
  This prospective study was carried out to evaluate the effectiveness and safety of upper calyceal versus lower calyceal puncture for the removal of complex renal stones through PCNL.
  
  
  METHODS
  A total of 94 patients underwent PCNL for complex renal stone in our institute. Fifty-one of them underwent lower calyceal, while 43 underwent upper calyceal puncture. The two approaches are compared as per total duration of surgery, intraoperative blood loss, infundibular/pelvic tear, rate of complete clearance and rate of postoperative complications (pulmonary, bleeding, fever and sepsis, etc.).
  
  
  RESULTS
  In our study, the success rate was 76.47% for those in the lower, 90.70% for those in the upper calyceal access group. Thoracic complications (hydrothorax) occurred to 1 patient in upper calyceal supracostal access group. Bleeding requiring blood transfusion happened to 5 patients in lower calyceal access and 1 in upper calyceal group.
  
  
  CONCLUSIONS
  In our study for the management of complex renal calculi, we conclude that in a previously unoperated kidney, upper calyceal puncture through subcostal or supra 12(th) rib is a feasible option minimizing lung/pleural rupture and gives a better clearance rate. We suggest that with due precautions, there should not be any hesitation for upper calyceal puncture in indicated patients.
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Rohit
authors: R
authors: Singh
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: S P
authors: SP
authors: Kankalia
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Vilas
authors: V
authors: Sabale
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Vikram
authors: V
authors: Satav
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Deepak
authors: D
authors: Mane
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Abhirudra
authors: A
authors: Mulay
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Bhupender
authors: B
authors: Kadyan
authors: Department of Urology, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors: Naveen
authors: N
authors: Thakur
keywords: Percutaneous nephrolithotomy; staghorn; supracostal puncture
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