Comparison of Upper Versus Lower Calyceal Puncture Technique In Percutaneous Nephrolithotomy For Complex Renal Calculi

Abstract

Objective: To compare upper and lower calyceal puncture techniques during percutaneous nephrolithotomy (PCNL) for complex renal calculi regarding stone clearance, operative time and postoperative complications.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Urology, Armed Forces Institute of Urology, from 24th Jan,2026 to 24th April,2026

Methodology: A total of 210 patients aged 18-60 years with complex renal calculi were enrolled by consecutive non-probability sampling and allocated using a computer-generated randomization sequence into Group-A (upper calyceal puncture) and Group-B (lower calyceal puncture). Patients with bleeding disorders, solitary functioning kidney, pregnancy, active untreated urinary tract infection or previous ipsilateral renal surgery were excluded. PCNL was performed under general anesthesia using fluoroscopic guidance. Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 23; normality was assessed by Shapiro-Wilk test. Chi-square/Fisher exact test was used, with p≤0.05 considered as significant.

Results: Mean age was 38.8 ± 10.0 years. Male to female ratio was 127:83, (approximately 1.5:1.), Complete stone clearance was higher in Group-A than Group-B (91.4% versus 77.1%; p=0.006), while residual stones were lower (8.6% versus 22.9%; p=0.006). Mean operative time was shorter in Group-A (78.5 ± 12.4 versus 85.2 ± 14.1 minutes). Bleeding, fever, second puncture and hospital stay >3 days were more frequent in Group-B but not statistically significant.

Conclusion: Upper calyceal puncture achieved better clearance and shorter operative time than lower calyceal puncture, with comparable early postoperative safety.