J Coll Physicians Surg Pak. 2025 Aug;35(8):1014-1018. doi: 10.29271/jcpsp.2025.08.1014.
ABSTRACT
OBJECTIVE: To compare the safety and efficacy of the mid-calyx access (MCA) and the lower-calyx access (LCA) in paediatric percutaneous nephrolithotomy (PCNL).
STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Paediatric Urology, Institute of Kidney Disease, Peshawar, Pakistan, from January 2022 to October 2024.
METHODOLOGY: Two hundred paediatric patients divided into two groups (85 MCA and 115 LCA) were retrospectively analysed. Demographic data, stone clearance rates, operative times, blood loss, postoperative complications, and hospital stays were compared. Statistical analysis was performed using the independent t-test and the Chi-square test, with significance set at p <0.05.
RESULTS: The mean age was similar between two groups (8.38 ± 3.94 vs. 8.42 ± 3.75 years, p = 0.94), and gender distribution was comparable (lower calyx: 53 females and 62 males; mid-calyx: 40 females and 45 males; p = 0.89). Stone clearance rates were also non-significant (MCA 90.59%, LCA 84.35%; p = 0.19). MCA had significantly shorter operative time (43.0 [41.0, 46.0] minutes compared to 54.0 [50.0, 57.5] minutes; p <0.001) and fewer urinary tract infections (10.59% compared to 21.74%; p = 0.03). Hospital stays were shorter for MCA (1.49 ± 0.22 days compared to 1.91 ± 0.77 days; p <0.001). Other complications, including bleeding, renal injury, and postoperative fever were rare and not significantly different between groups.
CONCLUSION: Both MCA and LCA are safe and effective for paediatric PCNL. MCA offers more advantages, including shorter operative time, reduced urinary infections, and faster recovery, making it a preferable option in selected cases.
KEY WORDS: Mid-calyx approach, Lower calyx approach, Percutaneous nephrolithotomy, Safety, Efficacy.
PMID:40843569 | DOI:10.29271/jcpsp.2025.08.1014
