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
| Autor: | Iason Kyriazis, Marinos Vasilas, Vasilios Panagopoulos, Wissam Kamal, Evangelos Liatsikos, Panagiotis Kallidonis |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Percutaneous Ureteral Calculi Urology medicine.medical_treatment Treatment outcome Operative Time 030232 urology & nephrology Blood Loss Surgical Punctures Lithotripsy Postoperative Hemorrhage Collection system Kidney Calices 03 medical and health sciences Kidney Calculi 0302 clinical medicine Postoperative Complications medicine Fluoroscopy Humans Blood Transfusion Kidney Pelvis Aged Nephrostomy Percutaneous medicine.diagnostic_test business.industry Fornix Kidney pelvis Middle Aged Surgery Treatment Outcome 030220 oncology & carcinogenesis Operative time Feasibility Studies Female Radiology business |
| Zdroj: | World journal of urology. 35(5) |
| ISSN: | 1433-8726 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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