SINGLE VERSUS MULTIPLE-TRACT PERCUTANEOUS NEPHROLITHOTOMY IN THE SURGICAL MANAGEMENT OF SINGLE LARGE STONE: PROSPECTIVE STUDY OF 50 CASES AT SINGLE CENTRE (OUR INSTITUTE).

Abstract

Purpose: Renal calculi are a common urological disorder characterized by a high recurrence rate. Single large calculus still represents an intractable challenge for urologists. Percutaneous nephrolithotomy (PCNL) is the gold standard procedure used for large kidney stones, and multiple tracts of PCNL are applied to achieve better stone clearance if not cleared by single tract PCNL. However, the creation of multiple tracts may have the potential risk of bleeding and higher complication rates compared with single-tract procedures. The purpose of this study is to assess the safety and efcacy of single tract access for single large renal calculi in comparison to multiple tract access. Records Materials and Methods: of 50 patients with single large calculi who underwent PCNL at our institution between January 2021 and Dec 2022 were studied prospectively. twenty-ve patients were managed by single-tract access (Group 1), and 25 patients underwent multiple-tract access (Group 2). Mean age was (42.84 years) Both groups were compared in terms of perioperative ndings and postoperative outcomes and complication like postoperative bleeding, post op fever, sepsis, pulmonary complication, necessitated blood transfusion and selective angio-embolization. Results: In group 1 the initial access were either superior, or middle, or inferior. In group 2 The mean number of percutaneous accesses in the multiple-tract group was (2.5), with most patients requiring two tracts. The mean duration of uoroscopy screening time is 3.22±0.85 in group 1 and 6.05±1.18 in group 2 which is higher compared to group 1. The operative time was 72.60±15.55 minutes in group 1 and group 2 it is 109.80±13.03 minutes which is longer in Group 2. Stone-free rates (in a view of with no residual stone) were 80% and 60% in Groups 1 and 2, respectively. The mean hospital stay was higher in group 2 compare to group 1. Complications included blood transfusion, resulting from a haemoglobin drop of 0.74±0.81 and 1.96±1.51 g/dL in Groups 1 and 2, respectively. Mean pre- and post-operative creatinine change were 0.26 mg/dL in Group 1 and 0.26 mg/dL in Group 2. Mean changes in creatinine values were not statistically was likely to fail signicant between the groups. Clavien–Dindo Classication Grade II complications included blood transfusion, which occurred in one patient in Group 1 and ve in Group 2, urosepsis occurred in two patients in group 2. Pseudoaneurysm attributed to Grade III complications occurred in one patient in Group 2. This study indicated that Conclusion. STPCNL is the only best an effective method for treating single large calculi. Compared with MTPCNL, STPCNL is associated with many advantages, less blood loss, fewer blood transfusions, fewer pulmonary complications without an increase in other complications and less hospital stay.