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Purpose: The aim of the current study was to compare Guy's score and STONE score in predicting the success and complication rate of percutaneous nephrolithotomy (PCNL). Materials and Methods: A total of 445 patients were included in the study between July 2015 and December 2016. The patients were given STONE score and Guy's Stone Score (GSS) grades based on CT scan done preoperatively and intra-and post-operative complications were graded using the modified Clavien grading system. The PCNL were done by a standard technique in prone positions. Results: The success rate in our study was 86.29% and both the GSS and STONE score were significantly associated with a success rate of the procedure. Both the scoring systems correlated with operative time and postoperative hospital stay. Of the total cases, 102 patients (22.92%) experienced complications. A correlation between STONE score stratified into low, moderate, and high nephrolithometry score risk groups (low scores 4-5, moderate scores 6-8, high scores 9-13), and complication was also found (P = 0.04) but not between the GSS and complication rate (P = 0.054). Conclusion: Both GSS and STONE scores are equally effective in predicting success rate of the procedure. [ABSTRACT FROM AUTHOR]

Objective: To present the experience of pediatric percutaneous nephrolithotomy (PCNL) of our center. Materials and Methods: This study was conducted from 1995 to 2015, on patients <15 years of age having renal and upper ureteral stones who underwent PCNL. Stones were classified as per Guy's stone score (GSS). Standard bull's eye technique was used for subcostal puncture. To avoid supracostal puncture, puncture was done in full inspiration or by oblique tract. If these maneuvers failed, then supracostal puncture was done. Tract was dilated to 24F. Results: Six hundred sixty PCNLs were performed on 639 patients. Puncture was subcostal in 87.6% cases with tract dilated as much as 24F. Pelvicaliceal system was most commonly accessed through middle calix (73.94%). Upper caliceal puncture (23.78%) was more frequently used in complete (82.35%) and partial staghorn (51%) stones. Two tracts were made in 16 (2.42%) cases, because of large stone burden. Average operative time was significantly longer in complex (45.43 minutes) compared to simple stones (29.39 minutes). Overall success rate was 94.39%, but it was significantly lower in partial (91.37%) and complete staghorn stones (82.35%). Complications were present in 21.66% cases and were classified according to Clavien grading. Majority of patients (97.9%) had minor complications (Clavien grade 1 & 2). On multivariate analysis, GSS ≥2, stone size >200 mm2, and multiple caliceal, partial, and complete staghorn stones were predictors of failure and complications. Conclusion: PCNL is a minimally invasive surgical technique for removal of renal and upper ureteral stones, which have low morbidity rate, high success rate, and short hospital stay. Although the uses of smaller instruments are on the rise, procedure can still be safely performed in children using adult instruments. Supracostal approach if done cautiously does not increase morbidity rate. [ABSTRACT FROM AUTHOR]

Purpose: Management of patients with complex multiple renal calculi has always remained challenging and they pose many difficulties during percutaneous nephrolithotomy (PCNL) like higher incidence of residual calculus and multiple tracts requirement. The aim of our study was to evaluate the impact of pelvicalyceal system (PCS) anatomy, stone distribution and the site of puncture on the outcome of PCNL in patients with complex multiple renal calculi. Materials and methods: One hundred and ten patients with complex multiple renal calculi undergoing PCNL during January 2015 to December 2015 were enrolled in our study. Pelvicalyceal anatomy and the stone distribution were determined from intravenous urography. PCNL was done using standard technique. We evaluated the impact of PCS anatomy, stone distribution and the site of puncture on the surgical outcome. Results: Of all the studied pelvicalyceal anatomy variables, infundibular width, intercalyceal angle and PCS surface area affected the number of punctures. Stone distribution involving all the three calyces or middle and lower calyces was most unfavourable for achieving complete stone clearance. The middle calyceal puncture was almost equally good as the upper calyceal puncture in achieving stone clearance. With timely multiple punctures done, there was neither significant haemoglobin fall nor creatinine rise. Conclusion: Pelvicalyceal anatomy, stone distribution and site of puncture impacts the number of punctures required and stone clearance achieved in patients with complex multiple renal calculi undergoing PCNL. Based on these parameters we can predict which patient has a high likelihood of requirement of multiple punctures. With timely multiple punctures done, there is neither significant haemoglobin fall nor creatinine rise. [ABSTRACT FROM AUTHOR]

Introduction: Access into the collecting system is considered to be the most critical step for Percutaneous Nephrolithotomy (PCNL). Aim: The present study provides a comparative view into antegrade air pyelography and retrograde air pyelography procedures for percutaneous renal access. Materials and Methods: A cross-sectional study was conducted on 100 patients with radiopaque renal calculi indicated for PCNL procedure. These patients were randomly assigned to two groups namely antegrade air pyelogram group (Group I) and retrograde air pyelogram group (Group II). In antegrade air pyelogram group, the collecting system was delineated by targeting the renal stone using a 22 gauge spinal needle where the patients were in the prone position. In another group, the collecting system was delineated by retrograde air pyelogram under fluoroscopy guidance. The method of tract dilatation and stone extraction were the same in both groups for comparison of outcome and complication. Results: The mean age of patients was 41.7±13 and 41.4±13.6 years in Group-I and Group-II respectively. The male to female ratio in Groups I and II was 35/15 (70.00%) and 38/12 (76.00%) respectively. In Group-I the average duration of access was 2.66±1.0 minutes after prone positioning whereas it was recorded to be 19.48±5.0 minutes in Group-II, after lithotomy followed by prone positioning of the patient. Duration of radiation exposure was almost similar in both groups. Additional procedural cost was significantly higher in Group II. Conclusion: Our study indicated that access for PCNL using antegrade air pyelogram can be a cost-effective and acceptable alternative to retrograde air pyelogram with decreased access time. [ABSTRACT FROM AUTHOR]