Upper pole access for percutaneous nephrolithotomy (PCNL) provides a straight access tract to the ureter with easier placement of a guidewire, good exposure of the pelvis and upper ureter, and comfortable manipulations for the treatment of staghorn, large upper caliceal, and multiple stones. However, despite these benefits, upper pole access is usually avoided because of the risk of chest complications in both paediatric and adult patients. These authors retrospectively reviewed patients aged <17 years with renal stones who underwent PCNL with a single access and evaluated its safety and morbidity. One hundred and one PCNL procedures were performed, 77 of which were managed with only one access. The median age of the 77 patients managed with a single access was 12 years (range 3-17 years). The number of cases in the single upper pole access group (SUPAG) and single other pole access group (SOPAG) was 10 and 67, respectively. They found no statistically significant differences between the SUPAG and SOPAG in terms of age, sex, stone location, hydronephrosis status, stone area, side of kidney, and previous stone treatment or renal surgery. Furthermore, there were no significant differences between the groups in terms of the operative parameters. There was no chest complication or bleeding that required transfusion in the SUPAG. These results indicate that upper pole access is a safe and effective approach for PCNL and it presents a good alternative for removal of renal stones in paediatric patients. Despite its principal limitations including the retrospective nature, the small number of cases of SUPAG, and the lack of randomisation, this claims to be the first study to compare only single access cases to determine the safety and efficiency of upper pole puncture in a paediatric population.

Upper pole access is safe and effective for paediatric percutaneous nephrolithotomy.
Oner S, Karagozlu Akgul A, Demirbas M, et al.
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Ravindar Anbarasan

Southampton Children’s Hospital.

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