Comparative assessment of multiple‐tract vs single‐tract percutaneous nephrolithotomy. Issue 4 (8th June 2022)

• Record Type: Journal Article
• Authors: Savko, Olga; Kurosch, Martin; Rothe, Nina; Dotzauer, Robert; Haferkamp, Axel; Mager, Rene
• Is Part Of: Asian journal of endoscopic surgery. Volume 15:Issue 4(2022)
• Page Start: 774
• Page End: 780
• Publication Date: 2022-06-08
• Subjects: multiple‐tract -- percutaneous nephrolithotomy -- staghorn calculi; Endoscopic surgery -- Periodicals; Endoscopic surgery -- Asia -- Periodicals; 617.05705
• DOI: 10.1111/ases.13092
• Languages: English
• ISSNs: 1758-5902

Abstract

Abstract: Introduction: To investigate the efficacy and safety of multi‐tract percutaneous nephrolithotomy (PNL) against the benchmark of the single‐tract approach. Methods: A retrospective analysis of 391 consecutive PNL procedures was conducted in our tertiary referral center between April 2016 and March 2020. 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 PNL and single‐tract PNL were performed in 37 (9%) and 354 (91%) cases respectively. At baseline, compared to single‐tract PNL, multi‐tract PNL cases were characterized by significantly larger stone burden (2.62 vs 0.97 cm 3, P < .00), lower Hounsfield units (HU) (751 vs 1017 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 (59 vs 19%, P < .00). Analysis of outcome revealed shorter operation time and length of hospital stay for single‐tract PNL compared to multi‐tract PNL ( P < .01). However, the difference in terms of stone‐free rates (92% vs 88%), complication rates (43% vs 28%) and time to active retreatment due to ipsilateral recurrence was not statistically significant ( P > .05). Conclusion: In this retrospective single‐center analysis, a multi‐tract PNL has been proved to be an efficient and safe expansion of single‐tract PNL 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.