title: Papillary vs Nonpapillary Puncture in Percutaneous Nephrolithotomy: A Prospective Randomized Trial.
abstract: BACKGROUND
  Literature suggests that the percutaneous punctures for percutaneous nephrolithotomy (PCNL) must be performed at the papilla of the renal calix and a puncture at the infundibulum or the direction of the pelvis is not advisable because of increased hemorrhagic risk. A prospective randomized study was conducted to investigate the safety in terms of blood loss of the infundibular approach for PCNL.
  
  
  METHODS
  Patients with renal stones with an accumulative size of at least 2 cm were randomly assigned to one of two parallel groups to undergo PCNL with either papillary (Group 1) or infundibular (Group 2) renal access. The primary outcome measures were the reduction in hemoglobin on first postoperative day and the need for transfusion during the first postoperative month. Secondary endpoints included the operative and fluoroscopy time, number of accesses performed, overall complication rate, hospitalization time, and complications up to 3 months.
  
  
  RESULTS
  In total, 27 and 28 patients were enrolled in Groups 1 and 2, respectively. Patient age, body mass index, and stone size were similar among the groups (p = 0.672, 0.256, and 0.889, respectively). Reduction in hemoglobin and transfusion rate did not differ among Groups 1 and 2 (p = 0.916, p = 1.0, respectively). Operative time was higher in the case of Group 1 (p = 0.027). The overall complications rate was 7.4% for Group 1 and 7.14% for Group 2. Hospitalization time was not significantly different in the study groups (p = 0.724).
  
  
  CONCLUSIONS
  The infundibular approach for PCNL to the posterior middle renal calices is not associated with higher blood loss or transfusion rate in comparison with the respective approach to the fornix of the papilla when the currently described technique is performed.
authors.affiliation: Department of Urology, University of Patras , Patras, Greece .
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.affiliation: Department of Urology, University of Patras , Patras, Greece .
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.affiliation: Department of Urology, University of Patras , Patras, Greece .
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kotsiris
authors.affiliation: Department of Urology, University of Patras , Patras, Greece .
authors.forename: Adamantia
authors.initials: A
authors.lastname: Koutava
authors.affiliation: Department of Urology, University of Patras , Patras, Greece .
authors.forename: Wissam
authors.initials: W
authors.lastname: Kamal
authors.affiliation: Department of Urology, University of Patras , Patras, Greece .
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liatsikos
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005471:Fluoroscopy; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000601:surgery; D007669:Kidney Calculi / Q000601:surgery*; D007670:Kidney Calices / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D011446:Prospective Studies; D011677:Punctures; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: infundibular; nephrolithotomy; papillary; percutaneous; randomized