Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study

摘要

Objective: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route Recent literature suggests that papillary access to renal calyx is the accepted method Despite this rule, we do not always make papillary puncture and we puncture wherever we can to achieve stonefree status and reduce unnecessary access In this study, we present our results with papillary vs nonpapillary access in patients with a kidney stone Material and methods: Two hundred and seven patients with nonpapillary access and 69 patients with papillary access who had similar demographics (age, body mass index (BMI), stone size) were selected with pair match analysis (3:1) Preoperative and postoperative data were collected from the patient's chart Operative time (from starting surgery to nephrostomy tube), dropin hematocrit level, transfusion rate, duration of hospital stay, perioperative and postoperative complications (ClavienDindo Classification) and stonefree status (no or 3 mm residual stone) were also evaluated in both groups Results: The mean operative time was similar in between two groups The mean hematocrit decreases not differ between the two groups (p = 056) In papillary group, only 2 patients (32%) required transfusion and only one patient (14%) in the nonpapillary group had a transfusion with no statistically significant difference (p = 043) The overall complication rates were 71% in the papillary group and 72% in the nonpapillary group (p = 089) Postoperative mean creatinine level was similar between the two groups Conclusions: In this study, we found that nonpapillary access is a feasible option for PCNL in the terms of stonefree status and complication rates.