title: Challenging the wisdom of puncture at the calyceal fornix in percutaneous nephrolithotripsy: feasibility and safety study with 137 patients operated via a non-calyceal percutaneous track.
abstract: OBJECTIVE
  To present our experience with a central, non-calyceal puncture protocol for percutaneous nephrolithotripsy (PCNL) in an attempt to challenge the opinion of worldwide adopted calyceal puncture as the less traumatic site of percutaneous entrance into the collecting system.
  
  
  METHODS
  During 2012, a total of 137 consecutive, unselected patients were subjected to PCNL in our department. Non-calyceal punctures were performed to all cases and followed by subsequent track dilations up to 30 Fr. Perioperative and postoperative data were prospectively collected and analyzed.
  
  
  RESULTS
  Mean operative time (from skin puncture to nephrostomy tube placement) was 48 min. Patients with single, multiple and staghorn stones had primary stone-free rates of 89.2, 80.4 and 66.7 % after PCNL, respectively. The overall complication rate was 10.2 %, while bleeding complications were minimal. Only 4 patients (2.9 %) required blood transfusion. Five patients (3.6 %) had Clavien Grade IIIa complications requiring an intervention for their management and none Grade IV or V.
  
  
  CONCLUSIONS
  Despite the absence of evidence that non-calyceal percutaneous tracts could be a risk factor for complications, the concept of calyceal puncture has been worldwide adopted by PCNL surgeons as the sole safe percutaneous entrance into the collective system. Based on our experience, other pathways than the worldwide recognized rule, calyceal puncture, are possible and probably not as dangerous as has been previously stated.
authors: Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece. jkyriazis@gmail.com.
authors: Iason
authors: http://orcid.org/0000-0003-3880-4963
authors: I
authors: Kyriazis
authors: Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece.
authors: Panagiotis
authors: P
authors: Kallidonis
authors: Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece.
authors: Marinos
authors: M
authors: Vasilas
authors: Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece.
authors: Vasilios
authors: V
authors: Panagopoulos
authors: Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece.
authors: Wissam
authors: W
authors: Kamal
authors: Department of Urology, Medical School, University of Patras, Rion, 26 500, Patras, Greece.
authors: Evangelos
authors: E
authors: Liatsikos
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007670:Kidney Calices / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy; D011677:Punctures / Q000379:methods*; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000601:surgery*
keywords: Access; Bleeding; Central puncture; Complications; Morbidity; Percutaneous nephrolithotripsy