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. 2022 Oct;15(4):774-780.
doi: 10.1111/ases.13092. Epub 2022 Jun 8.

Comparative assessment of multiple-tract vs single-tract percutaneous nephrolithotomy

Olga Savko  1 , Martin Kurosch  1 , Nina Rothe  1 , Robert Dotzauer  1 , Axel Haferkamp  1 , Rene Mager  1
Affiliations

Comparative assessment of multiple-tract vs single-tract percutaneous nephrolithotomy

Olga Savko et al. Asian J Endosc Surg. 2022 Oct.

Abstract

Introduction: To investigate the efficacy and safety of multi-tract percutaneous nephrolithotomy (PNL) against the benchmark of the single-tract approach.

Methods: A retrospective analysis of 391 consecutive PNL procedures was conducted in our tertiary referral center between April 2016 and March 2020. Clinical outcome parameters such as stone-free rate, operation time, postoperative complications according to Clavien-Dindo, length of hospital stay and time to ipsilateral recurrence resulting in active treatment were assessed.

Results: Multi-tract PNL and single-tract PNL were performed in 37 (9%) and 354 (91%) cases respectively. At baseline, compared to single-tract PNL, multi-tract PNL cases were characterized by significantly larger stone burden (2.62 vs 0.97 cm3 , P < .00), lower Hounsfield units (HU) (751 vs 1017 HU, P < .01), a more complex S.T.O.N.E. (size, tract length, obstruction, number of calyces, essence) score (P < .00) and a higher rate of high-risk stone formers (59 vs 19%, P < .00). Analysis of outcome revealed shorter operation time and length of hospital stay for single-tract PNL compared to multi-tract PNL (P < .01). However, the difference in terms of stone-free rates (92% vs 88%), complication rates (43% vs 28%) and time to active retreatment due to ipsilateral recurrence was not statistically significant (P > .05).

Conclusion: In this retrospective single-center analysis, a multi-tract PNL has been proved to be an efficient and safe expansion of single-tract PNL for large stone burden and complex kidney stone disease. Future prospective research should focus on the procedure's potential effectiveness in reducing the number of interventions until stone-free status in patients with massive stone disease.

Keywords: multiple-tract; percutaneous nephrolithotomy; staghorn calculi.

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