Van der Jeugt Jolien, Aparicio Coral Manso, Martínez Sebastián Valverde, Chikhaoui Amal Aderghal, Martín Enrique González, Cepeda Marcos
Department of Urology, Río Hortega University Hospital (HURH), C. Dulzaina 2, Valladolid, 47012, Spain.
Department of Urology, AZ Rivierenland, Bornem, Belgium.
Urolithiasis. 2025 Mar 26;53(1):60. doi: 10.1007/s00240-025-01700-9.
The feasibility and safety of upper calyx access in supine percutaneous nephrolithotomy (PCNL) remains controversial. We aimed to detail our technique and describe the outcomes in effectivity as well as safety in a large cohort. The authors analyzed patients with renal and proximal ureteral stones who underwent supine PCNL using upper calyx access at Rio Hortega University Hospital Valladolid (Spain) between 2013 and 2023. Patients were placed in the Galdakao-modified supine Valdivia position. Transpapillary percutaneous access to the upper calyx was guided by a combination of ultrasound (US) and fluoroscopy. Stone-free rate (SFR) was assessed by residual fragments < 4 mm assessed by non-contrast CT scan (NCCT) two months postoperatively. The 30-days complications were classified using the PCNL-specific Clavien-Dindo score. One hundred patients were included in the study. Thirty-three (33.3%) were diagnosed with staghorn stones, and 44 (44.4%) with multiple calculi. Upper calyx access was achieved supra-11th rib in 31 (31.9%), supra-12th rib in 64 (66%) and subcostal in 2 (2.1%) cases. Miniaturized PCNL was performed in 64 (64.6%) patients. Median surgical time was 117.5 (100; 150) minutes. There were no intraoperative complications and in 62.1% of the cases, a nephrostomy tube was not necessary. The median hospital stay was 3 (1; 5) days. Twenty-seven postoperative complications occurred, including 8% grade I complications. Grade II complications including the need for blood transfusion and antibiotics occurred in 5% and 9%. Grade III complications were noted in 5%, and no grade IV or V were observed. There were no significant thoracic, liver or spleen complications. The single-procedure SFR was 85%, with only 3 patients requiring a second intervention. US and fluoroscopy guided percutaneous access to the upper calyx in the supine position is feasible and demonstrates a low complication rate alongside a high SFR.
仰卧位经皮肾镜取石术（PCNL）中对上盏穿刺的可行性和安全性仍存在争议。我们旨在详细介绍我们的技术，并描述一大群患者在有效性和安全性方面的结果。作者分析了2013年至2023年期间在西班牙巴利亚多利德里奥奥尔特加大学医院接受仰卧位PCNL并采用上盏穿刺的肾及近端输尿管结石患者。患者采用改良的仰卧位瓦尔迪维亚体位（Galdakao-modified supine Valdivia position）。在超声（US）和荧光透视的联合引导下经乳头对上盏进行经皮穿刺。术后两个月通过非增强CT扫描（NCCT）评估残留碎片<4 mm来评估结石清除率（SFR）。使用PCNL特异性的Clavien-Dindo评分对30天并发症进行分类。100例患者纳入本研究。33例（33.3%）诊断为鹿角形结石，44例（44.4%）为多发结石。31例（31.9%）患者的上盏穿刺在第11肋以上完成，64例（66%）在第12肋以上，2例（2.1%）在肋下完成。64例（64.6%）患者进行了微创PCNL。中位手术时间为117.5（100；150）分钟。无术中并发症，62.1%的病例无需留置肾造瘘管。中位住院时间为3（1；5）天。发生27例术后并发症，其中I级并发症占8%。II级并发症（包括输血和使用抗生素）分别占5%和9%。III级并发症占5%，未观察到IV级或V级并发症。无明显的胸部、肝脏或脾脏并发症。单次手术的SFR为85%，仅3例患者需要二次干预。超声和荧光透视引导下仰卧位经皮对上盏穿刺是可行的，并发症发生率低，结石清除率高。
