MP29-03: Compare safety and efficacy of multiple-tract vs single-tract percutaneous nephrolithotomy, A single-center experience.
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Kamran Hassan Bhatti*, Alkhor, Qatar
Introduction
Renal stones are one of the most common urinary tract disorders [1]. Management of such stones depends on many factors like stone size, site, complexity, and patient factors [2]. In complex renal stones, PCNL is a safe and efficient tool in the armamentarium of renal stone management with a relatively low incidence of significant complications. Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large complex renal stones and staghorn calculi [4]. In complex and staghorn stones with multiple calyceal involvement, access to all the calyces is difficult through one percutaneous tract, in which case multiple-access PCNL is the mainstay of treatment to achieve better stone clearance and reduce the need for secondary ESWL. However, multiple-tract procedures have been associated with increased bleeding and transfusion rates [5]. In this study, the primary endpoint was to evaluate the effectiveness of multiple puncture PCNL in complex renal stones. The secondary endpoint was to investigate the safety and complication rate of this approach.
Methods
Methods: A retrospective analysis of 500 consecutive PCNL procedures was conducted in our tertiary referral center between JAN 2014 and DEC 2022.Clinical outcome parameters such as stone-free rate, operation time, postoperative complications according to Clavien–Dindo, length of hospital stay and time to ipsilateral recurrence resulting in active treatment were assessed.
Results
Multi-tract PCNL and single-tract PCNL were performed in 50 (10 %) and 450 (90%) cases respectively. At baseline, compared to single-tract PNL, multi-tract PCNL cases were characterized by significantly larger stone burden (2.48vs 0.92 cm3,P< .00), lower Hounsfield units (HU) (855 vs 1009 HU,P< .01), a more complex S.T.O.N.E. (size, tract length, obstruction, number of calyces, essence) score (P< .00) and a higher rate of high-risk stone formers (47 vs 16 %,P< .00). Analysis of outcome revealed shorter operation time and length of hospital stay for single-tract PCNL compared to multi-tract PCNL (P< .01). How-ever, the difference in terms of stone-free rates (86% vs 84%), complication rates (36 % vs 22 %) and time to active retreatment due to ipsilateral recurrence was not statistically significant (P> .05).
Conclusions
In this retrospective single-center analysis, a multi-tract PCNL has been proved to be an efficient and safe expansion of single-tract PCNL for large stone burden and complex kidney stone disease. Future prospective research should focus on the procedure's potential effectiveness in reducing the number of interventions until stone-free status in patients with massive stone disease. KEYWORDS multiple-tract, percutaneous nephrolithotomy, staghorn calculi
Source Of Funding
NIL
Author Block
Kamran Hassan Bhatti*, Alkhor, Qatar
Introduction
Renal stones are one of the most common urinary tract disorders [1]. Management of such stones depends on many factors like stone size, site, complexity, and patient factors [2]. In complex renal stones, PCNL is a safe and efficient tool in the armamentarium of renal stone management with a relatively low incidence of significant complications. Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large complex renal stones and staghorn calculi [4]. In complex and staghorn stones with multiple calyceal involvement, access to all the calyces is difficult through one percutaneous tract, in which case multiple-access PCNL is the mainstay of treatment to achieve better stone clearance and reduce the need for secondary ESWL. However, multiple-tract procedures have been associated with increased bleeding and transfusion rates [5]. In this study, the primary endpoint was to evaluate the effectiveness of multiple puncture PCNL in complex renal stones. The secondary endpoint was to investigate the safety and complication rate of this approach.
Methods
Methods: A retrospective analysis of 500 consecutive PCNL procedures was conducted in our tertiary referral center between JAN 2014 and DEC 2022.Clinical outcome parameters such as stone-free rate, operation time, postoperative complications according to Clavien–Dindo, length of hospital stay and time to ipsilateral recurrence resulting in active treatment were assessed.
Results
Multi-tract PCNL and single-tract PCNL were performed in 50 (10 %) and 450 (90%) cases respectively. At baseline, compared to single-tract PNL, multi-tract PCNL cases were characterized by significantly larger stone burden (2.48vs 0.92 cm3,P< .00), lower Hounsfield units (HU) (855 vs 1009 HU,P< .01), a more complex S.T.O.N.E. (size, tract length, obstruction, number of calyces, essence) score (P< .00) and a higher rate of high-risk stone formers (47 vs 16 %,P< .00). Analysis of outcome revealed shorter operation time and length of hospital stay for single-tract PCNL compared to multi-tract PCNL (P< .01). How-ever, the difference in terms of stone-free rates (86% vs 84%), complication rates (36 % vs 22 %) and time to active retreatment due to ipsilateral recurrence was not statistically significant (P> .05).
Conclusions
In this retrospective single-center analysis, a multi-tract PCNL has been proved to be an efficient and safe expansion of single-tract PCNL for large stone burden and complex kidney stone disease. Future prospective research should focus on the procedure's potential effectiveness in reducing the number of interventions until stone-free status in patients with massive stone disease. KEYWORDS multiple-tract, percutaneous nephrolithotomy, staghorn calculi
Source Of Funding
NIL