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PCNL for Lower Pole Calyceal Stones

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Percutaneous Renal Surgery

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Abstract

Lower pole calyceal stones (LPCS) constitute approximately 35% of all renal stones, and 50% of these stones will require some kind of intervention within five years. Percutaneous nephrolithotripsy (PCNL) and its variants (miniperc, ultra miniperc, and microperc) are comparable to flexible ureteroscopy (FURS) in the treatment of LPCS between 10 and 20 mm, presenting a slightly better stone-free rate but is more invasive with higher blood loss and more pain. For stones > 20 mm, PCNL has a significantly higher stone-free rate than FURS. A one-week antibiotic regimen is recommended for high-risk patients. No significant differences have been found between the prone and supine decubitus positions. The lower pole is accessed directly by fluoroscopy or ultrasound-guided puncture, and after dilation of the tract, a nephroscope is introduced. Stones can be fragmented or removed using forceps. Nephrostomy can be left if necessary, or a ureteral stent is inserted at the end of the procedure and removed on the first or second postoperative day. Complications of PCNL occur in approximately 7% of patients and include bleeding, injury to the adjacent organs, and infection. Ambulatory PCNL is reported to be both safe and effective.

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Authors and Affiliations

  1. Urology and Head of Endourology Section, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil

    Eduardo Mazzucchi

  2. Urology, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil

    Alexandre Danilovic & Fabio Carvalho Vicentini

Authors
  1. Eduardo Mazzucchi
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  2. Alexandre Danilovic
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  3. Fabio Carvalho Vicentini
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Correspondence to Eduardo Mazzucchi .

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Editors and Affiliations

  1. Western University, London, ON, Canada

    John D. Denstedt

  2. University Hospital of Patras, Patras, Greece

    Evangelos N. Liatsikos

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Mazzucchi, E., Danilovic, A., Vicentini, F.C. (2023). PCNL for Lower Pole Calyceal Stones. In: Denstedt, J.D., Liatsikos, E.N. (eds) Percutaneous Renal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-40542-6_20

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  • DOI: https://doi.org/10.1007/978-3-031-40542-6_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-40541-9

  • Online ISBN: 978-3-031-40542-6

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