Comparison of Papillary and Non-papillary Access to the Calyces in Patients Undergoing Percutaneous Lithotripsy

Abstract

Background: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Objectives: This study compared papillary access to the calyx with non-papillary access in patients who underwent PCNL. Methods: This retrospective cohort study reviewed the medical records of patients who underwent PCNL between January 2022 and June 2023. A total of 103 patients (55 with papillary access and 48 with non-papillary access) were included in this study. Collected data included patient demographics, pre- and post-operative laboratory values (hemoglobin and creatinine), and documented surgical complications (intraoperative and postoperative bleeding, pleural injury, colon injury, urinary leakage, and abscess formation). Results: Of the 103 patients, 63 were male and 40 were female. The mean age of all PCNL patients was 42.3 ± 8.6 years (range: 20 - 60). The mean Body Mass Index (BMI) was 28.99 ± 5.34 kg/m2 in the papillary group and 26.73 ± 4.03 kg/m2 in the non-papillary group. The mean operative time was 60.72 ± 15.8 minutes in the papillary group and 56.78 ± 11.33 minutes in the non-papillary group. The mean patient weight was 81.5 ± 12.9 kg in the papillary group and 76.08 ± 14.80 kg in the non-papillary group. No statistically significant differences were observed between the groups for these variables (P > 0.05). Postoperative hemoglobin decrease, pleural injury, colon injury, infection, stone-free rate, and urinary leakage rates between papillary and non-papillary groups reported no statistically significant differences. Conclusions: This study concluded that non-papillary access is a feasible option for PCNL in terms of stone-free status and complication rates.