title: Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones.
abstract: The objective of this study is to assess the efficacy of superior calyceal access versus inferior calyceal access for inferior calyceal calculi with or without pelvic calculi. A total of 100 patients with inferior calyceal calculi or inferior calyceal calculi with pelvic calculi were included in this prospective randomized study. In 50 patients (Group 1), a fluoroscopy-assisted superior calyceal puncture was made, and in other 50 patients (Group 2), access was obtained through a fluoroscopy-assisted inferior calyceal puncture. The stone-free rates, hemoglobin drop, operative duration, requirement for additional tracts, complications, and auxiliary procedures in the two groups were compared. Stone clearance rates and hemoglobin drop values were better in group 1, though they were not statistically significant. The mean operative duration, number of tracts required, and the relook procedure rate were significantly in favor of Group 1. Only one patient (2%) in Group 1 developed hydropneumothorax related to supracostal puncture and required intercostal tube drainage. Superior calyceal puncture (supracostal or infracostal) provides favorable access to inferior calyceal stones, providing better and faster clearance with less requirement of secondary tracts and auxiliary procedures.
authors.affiliation: Department of Urology, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India.
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Urology, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India. dryogeshgarg@rediffmail.com.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Garg
authors.affiliation: Department of Urology, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India.
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Urology, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India.
authors.forename: Rahul Janak
authors.initials: RJ
authors.lastname: Sinha
authors.affiliation: Department of Urology, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000328:Adult; D005260:Female; D005471:Fluoroscopy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006872:Hydropneumothorax / Q000209:etiology / Q000601:surgery; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D007670:Kidney Calices / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010388:Pelvis / Q000601:surgery*; D011446:Prospective Studies; D011897:Random Allocation; D000069258:Thoracentesis; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: Inferior calyceal access; Inferior calyceal calculi; Percutaneous nephrolithotomy; Superior calyceal access