Safety and complications of upper pole puncture in supine percutaneous nephrolithotomy.
10 affiliations
- 1Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
- 2Department of Urology, Georgetown University, Washington, DC, USA.
- 3Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
- 4Department of Urology, San Raffaele Hospital, Milan, Italy.
- 5Department of Urology, Hospital Angeles Leon, Guanajuato, Mexico.
- 6Department of Urology, University of California in Los Angeles, Los Angeles, USA.
- 7Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- 8Department of Urology, Royal Free Hospital, London, England.
- 9Department of Urology, Brigham and Women's Hospital, Boston, USA.
- 10Department of Urology, Tulane University, 4224 Houma Blvd, Suite 640 Metairie, New Orleans, LA, 70006 , USA. [email protected].
Abstract
Objective
Supine percutaneous nephrolithotomy (PCNL) has gained attention as a viable alternative to the traditional/historical prone approach for the treatment of large renal stones. However, concerns remain regarding the safety and feasibility of upper calyx punctures in the supine position, particularly for upper-pole access. This multicenter, retrospective cohort study evaluated the safety and stone-free rates of upper-pole punctures in supine PCNL, comparing outcomes with middle and lower calyx punctures and with literature on prone PCNL.Methods
This retrospective study analyzed supine PCNL cases performed between 2009 and 2019 across eight international centers, categorizing patients by calyx of entry (upper, middle, or lower). Patients who required multiple calyx entries were excluded. Demographics, surgical details, and outcomes were recorded, including complications and stone-free rates. We used logistic regression to assess the association between stone-free rates and calyx puncture sites, adjusting for age, gender, Guy's Stone Score, and ASA score. Based on the initial findings, we performed a second multivariable logistic regression among patients undergoing upper calyx puncture using the same covariates. ANOVA was used to compare the means of quantitative variables, and Chi-square tests assessed associations between categorical variables. Bonferroni adjustment was applied when appropriate.Results
Among 989 patients, 10% had upper, 28.5% middle, and 61.5% lower calyx punctures. No significant differences were found in overall complication rates when comparing upper, middle, and lower calyces. Thoracic complications were rare and did not differ significantly across calyces (p = 0.74). Upper calyx punctures had lower stone-free rates (51%) compared to middle (77.7%) and lower (62.8%) punctures (p < 0.001). The overall complication rate did not differ significantly (p = 0.82). According to the logistic regression, patients with a middle puncture site had 2.98 times higher odds of a stone-free outcome than those with an upper puncture site (OR, 2.98; 95% CI, 1.69-5.29). In contrast, patients with a lower puncture site did not have a significant difference in stone-free rates compared to those with an upper puncture (OR = 1.10, 95% CI: 0.64, 1.86, p = 0.7). Among patients undergoing upper calyx puncture, Guy's Stone Score 4 was independently associated with lower odds of achieving stone-free status (OR 0.20, 95% CI 0.04-0.91; p = 0.045). No significant associations were observed for age, gender, or ASA classification.Conclusion
Upper calyx punctures showed similar complication rates to middle and lower calyx punctures, with slightly lower stone-free rates likely due to higher stone complexity. These findings support the feasibility, safety, and efficacy of supine PCNL for upper calyx access.
Related
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BibTeX
@article{villanuevacongote2026safety,
title = {{Safety and complications of upper pole puncture in supine percutaneous nephrolithotomy.}},
author = {Juliana Villanueva-Congote and Yi W Li and Michal Segall and Mehmet Gokce and Silvia Proietti and Guido Giusti and Jose Ernesto Torres Garcia and Braulio Manzo and Alan Yaghoubian and Mariano Gonzalez and Leye Ajayi and Daniel A Wollin and Brian H Eisner},
journal = {World journal of urology},
year = {2026},
month = oct,
doi = {10.1007/s00345-026-06735-0},
url = {https://europepmc.org/article/MED/42873281},
note = {CC BY},
}
RIS
TY - JOUR
TI - Safety and complications of upper pole puncture in supine percutaneous nephrolithotomy.
AU - Juliana Villanueva-Congote
AU - Yi W Li
AU - Michal Segall
AU - Mehmet Gokce
AU - Silvia Proietti
AU - Guido Giusti
AU - Jose Ernesto Torres Garcia
AU - Braulio Manzo
AU - Alan Yaghoubian
AU - Mariano Gonzalez
AU - Leye Ajayi
AU - Daniel A Wollin
AU - Brian H Eisner
PY - 2026
DA - 2026/10/14
JO - World journal of urology
DO - 10.1007/s00345-026-06735-0
UR - https://europepmc.org/article/MED/42873281
AB - Objective Supine percutaneous nephrolithotomy (PCNL) has gained attention as a viable alternative to the traditional/historical prone approach for the treatment of large renal stones. However, concerns remain regarding the safety and feasibility of upper calyx punctures in the supine position, particularly for upper-pole access. This multicenter, retrospective cohort study evaluated the safety and stone-free rates of upper-pole punctures in supine PCNL, comparing outcomes with middle and lower calyx punctures and with literature on prone PCNL.Methods This retrospective study analyzed supine PCNL cases performed between 2009 and 2019 across eight international centers, categorizing patients by calyx of entry (upper, middle, or lower). Patients who required multiple calyx entries were excluded. Demographics, surgical details, and outcomes were recorded, including complications and stone-free rates. We used logistic regression to assess the association between stone-free rates and calyx puncture sites, adjusting for age, gender, Guy's Stone Score, and ASA score. Based on the initial findings, we performed a second multivariable logistic regression among patients undergoing upper calyx puncture using the same covariates. ANOVA was used to compare the means of quantitative variables, and Chi-square tests assessed associations between categorical variables. Bonferroni adjustment was applied when appropriate.Results Among 989 patients, 10% had upper, 28.5% middle, and 61.5% lower calyx punctures. No significant differences were found in overall complication rates when comparing upper, middle, and lower calyces. Thoracic complications were rare and did not differ significantly across calyces (p = 0.74). Upper calyx punctures had lower stone-free rates (51%) compared to middle (77.7%) and lower (62.8%) punctures (p < 0.001). The overall complication rate did not differ significantly (p = 0.82). According to the logistic regression, patients with a middle puncture site had 2.98 times higher odds of a stone-free outcome than those with an upper puncture site (OR, 2.98; 95% CI, 1.69-5.29). In contrast, patients with a lower puncture site did not have a significant difference in stone-free rates compared to those with an upper puncture (OR = 1.10, 95% CI: 0.64, 1.86, p = 0.7). Among patients undergoing upper calyx puncture, Guy's Stone Score 4 was independently associated with lower odds of achieving stone-free status (OR 0.20, 95% CI 0.04-0.91; p = 0.045). No significant associations were observed for age, gender, or ASA classification.Conclusion Upper calyx punctures showed similar complication rates to middle and lower calyx punctures, with slightly lower stone-free rates likely due to higher stone complexity. These findings support the feasibility, safety, and efficacy of supine PCNL for upper calyx access.
SN - 0724-4983
SN - 1433-8726
ER -