ABSTRACT
Abstract Upper Pole versus Lower Pole Access for Percutaneous Nephrolithotomy (PCNL) in Patients with Multiple Renal Calculi Wisoot Kangchareonsombat MD* Patric Villacuna MD** Vincent G Bird MD** Charles M Lynne MD** Raymond J Leveillec MD** * Department of Surgery, VMA Medical College and Vajira Hospital ** Department of Surgery, University of Miami School of Medicine, USA Objective: To compare the results of percutaneous nephrolithotomy (PCNL) between upper pole and lower pole access. Study design: Cross-sectional study. Subjects: Eighty four renal units in 78 patients with multiple stones and total stone size 2 cm without staghorn calculi who underwent PCNL at University of Miami School of Medicine, during 1999-2003 were selected. The accesses were divided in 2 groups; first, upper pole access in 57 renal units and second, lower pole access in 27 renal units. Methods: Hospital records, operative reports were retrospectively reviewed. Estimated blood loss, length of hospital stay, number of procedures (for stone free status) and complications were analyzed and compared. Main outcome measures: Estimated blood loss, length of hospital stay, number of procedures and complications. Results: The estimated blood loss (ml), length of hospital stay (hr) and number of procedures in groups 1 and 2 were 133/111 ml., 39/38 hrs., and 1.5/1.7 time respectively with p-value 0.05. There were 3 complications in group 1; consisted of pneumothorax, pulmonary edema and febrile UTL. In group 2, febrile UTI was the sole complication. Conclusion: The estimated blood loss, length of hospital stay and number of procedures were not different statistically significance. Moreover, very few complications occur in both accesses. Then, PCNL via upper and lower pole were safe and effective. Key words: percutaneous nephrolithotomy, upper pole access, lower pole access Vajira Med J 2006 ; 50 : 21 - 25