Open Access

ARTICLE

Percutaneous nephrolithotomy for complex renal calculi: is multi-tract approach OK?

Hyuk Jin Cho, Ji Youl Lee, Sae Woong Kim, Tae-Kon Hwang, Sung-Hoo Hong

Department of Urology, Seoul St Mary’s Hospital, The Catholic University of Korea College of Medicine, Korea
Address correspondence to Dr. Sung-Hoo Hong, Department of Urology, The Catholic University of Korea College of Medicine, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea

Canadian Journal of Urology 2012, 19(4), 6360-6365.

Abstract

Introduction: To compare the safety and efficacy of multiple-tract percutaneous nephrolithotomy (PCNL) with single-tract PCNL for complex renal stones.
Materials and methods: A total of 109 consecutive PCNL procedures for unilateral complex renal calculi (staghorn or complex caliceal calculi) were performed at our institution. Thirty patients received multiple-tract PCNL and 79 patients underwent single-tract PCNL. The two groups had comparable demographic data, except for a smaller stone burden and fewer complete staghorn calculi in those undergoing single-tract PCNL. Variables of interest included operative time, blood loss, change in serum creatinine, transfusion rates, length of hospital stay, stone clearance, number of ancillary procedures, and complication rates.
Results: The number of tracts used for multiple-tract PCNL was two in 20 patients, three in 9, and four in 1. No significant differences were observed when comparing single-tract PCNL with multiple-tract PCNL in terms of success rate, operative time, transfusion rate, drop in hemoglobin, hospitalization time, complication rate, or rise in serum creatinine. However, the need for ancillary procedures was more common in patients undergoing multiple-tract PCNL (53.3% versus 24.1%; p = 0.003). No long-term sequelae were noted during the median follow-up of 24 months in any patient.
Conclusions: The results of the present study show that multi-tract PCNL for appropriately chosen stones/patients has similar safety and effectiveness as single-tract PCNL in patients with smaller and less complex stones.

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