Multiple-tract percutaneous nephroureteral access prior to percutaneous nephrolithotomy/-tripsy (PCNL) for large stone burden does not increase periprocedural morbidity compared to traditional single-tract access

PurposeTo compare the safety profile of multiple-tract percutaneous nephrostomy access prior to percutaneous nephrolithotomy/tripsy (PCNL) for large stone burden to traditional single-tract access.MaterialsData from 31 patients (37 renal units) undergoing PCNL over a 4-month period at a single institution were retrospectively analyzed. Twelve patients (5 men; avg age 52 yrs) underwent multiple-tract access (16 renal units) and 19 patients (7 men; avg age 57 yrs) underwent single-tract access (21 renal units). Percutaneous access was obtained by interventional radiology 1 day prior to PCNL performed by urology. Periprocedural morbidity between the two cohorts were compared.ResultsAn intercostal approach was used in 9 of 21 (43%) of the single-tract accesses and 16 of 31 (47%) of the multi-tract accesses. The number of multiple tracts ranged from 2-3 per kidney, with 2 tracts being the most common. Average pre-procedure creatinine in the single-tract cohort was 1.07 mg/dl, with an average post-PCNL drop of 0.02 mg/dl. Average pre-procedure creatinine in the multi-tract group was 1.14 mg/dl, with an average post-PCNL drop of 0.6 mg/dl. Average pre-procedure hemoglobin level was 12.7 g/dL in the single-tract group with an average drop of 1.1 g/dL per renal unit. Average pre-procedure hemoglobin was 11.87 g/dL in the multi-tract group with an average drop of 1.5 g/dL per renal unit. Average recorded estimated blood loss was 92.0 cc/renal unit in the single-tract group and 131.7 cc/renal unit in the multi-tract group. Average operative time was 58.8 min/renal unit in the single-tract group and 56.2 min/renal unit in the multi-tract group. There was no difference in the number of complications between groups. Blood loss requiring transfusion was the only complication, one patient in each group received 2 units packed red blood cells.ConclusionsMultiple-tract PCNL access for large stone burden exhibits a similar safety profile to single-tract access at our institution, providing additional intra-operative approaches without an increase in periprocedural morbidity. There was a modest trend towards shorter operative times in the multi-tract cohort, despite a larger average stone burden.References1. Staghorn Calculi—Safety and Efficacy of Multiple Tracts Percutaneous Nephrolithotomy. J Urol 2008; 71(6):1039–1042. 10.1016/j.urology.2007.11.072.2. Hegarty N, Desai M. Percutaneous Nephrolithotomy Requiring Multiple Tracts- Comparison of Morbidity with Single-Tract Procedures. J Endourology 2006; 20(10):753–760.3. Patel S, Nakada S. The Modern History and Evolution of Percutaneous Nephrolithotomy. J Endourol 2015; 29(2):153–157. 10.1089/end.2014.0287. PurposeTo compare the safety profile of multiple-tract percutaneous nephrostomy access prior to percutaneous nephrolithotomy/tripsy (PCNL) for large stone burden to traditional single-tract access. To compare the safety profile of multiple-tract percutaneous nephrostomy access prior to percutaneous nephrolithotomy/tripsy (PCNL) for large stone burden to traditional single-tract access. MaterialsData from 31 patients (37 renal units) undergoing PCNL over a 4-month period at a single institution were retrospectively analyzed. Twelve patients (5 men; avg age 52 yrs) underwent multiple-tract access (16 renal units) and 19 patients (7 men; avg age 57 yrs) underwent single-tract access (21 renal units). Percutaneous access was obtained by interventional radiology 1 day prior to PCNL performed by urology. Periprocedural morbidity between the two cohorts were compared. Data from 31 patients (37 renal units) undergoing PCNL over a 4-month period at a single institution were retrospectively analyzed. Twelve patients (5 men; avg age 52 yrs) underwent multiple-tract access (16 renal units) and 19 patients (7 men; avg age 57 yrs) underwent single-tract access (21 renal units). Percutaneous access was obtained by interventional radiology 1 day prior to PCNL performed by urology. Periprocedural morbidity between the two cohorts were compared. ResultsAn intercostal approach was used in 9 of 21 (43%) of the single-tract accesses and 16 of 31 (47%) of the multi-tract accesses. The number of multiple tracts ranged from 2-3 per kidney, with 2 tracts being the most common. Average pre-procedure creatinine in the single-tract cohort was 1.07 mg/dl, with an average post-PCNL drop of 0.02 mg/dl. Average pre-procedure creatinine in the multi-tract group was 1.14 mg/dl, with an average post-PCNL drop of 0.6 mg/dl. Average pre-procedure hemoglobin level was 12.7 g/dL in the single-tract group with an average drop of 1.1 g/dL per renal unit. Average pre-procedure hemoglobin was 11.87 g/dL in the multi-tract group with an average drop of 1.5 g/dL per renal unit. Average recorded estimated blood loss was 92.0 cc/renal unit in the single-tract group and 131.7 cc/renal unit in the multi-tract group. Average operative time was 58.8 min/renal unit in the single-tract group and 56.2 min/renal unit in the multi-tract group. There was no difference in the number of complications between groups. Blood loss requiring transfusion was the only complication, one patient in each group received 2 units packed red blood cells. An intercostal approach was used in 9 of 21 (43%) of the single-tract accesses and 16 of 31 (47%) of the multi-tract accesses. The number of multiple tracts ranged from 2-3 per kidney, with 2 tracts being the most common. Average pre-procedure creatinine in the single-tract cohort was 1.07 mg/dl, with an average post-PCNL drop of 0.02 mg/dl. Average pre-procedure creatinine in the multi-tract group was 1.14 mg/dl, with an average post-PCNL drop of 0.6 mg/dl. Average pre-procedure hemoglobin level was 12.7 g/dL in the single-tract group with an average drop of 1.1 g/dL per renal unit. Average pre-procedure hemoglobin was 11.87 g/dL in the multi-tract group with an average drop of 1.5 g/dL per renal unit. Average recorded estimated blood loss was 92.0 cc/renal unit in the single-tract group and 131.7 cc/renal unit in the multi-tract group. Average operative time was 58.8 min/renal unit in the single-tract group and 56.2 min/renal unit in the multi-tract group. There was no difference in the number of complications between groups. Blood loss requiring transfusion was the only complication, one patient in each group received 2 units packed red blood cells. ConclusionsMultiple-tract PCNL access for large stone burden exhibits a similar safety profile to single-tract access at our institution, providing additional intra-operative approaches without an increase in periprocedural morbidity. There was a modest trend towards shorter operative times in the multi-tract cohort, despite a larger average stone burden. Multiple-tract PCNL access for large stone burden exhibits a similar safety profile to single-tract access at our institution, providing additional intra-operative approaches without an increase in periprocedural morbidity. There was a modest trend towards shorter operative times in the multi-tract cohort, despite a larger average stone burden.