Stag horn calculus may require PCNL through superior calyceal access alone or with accessory tracts through middle or lower calyx. How safe is it ?
The superior calix puncture is safe and effective even in pediatric population. An overall SFR of 90% was reported and 84% in cases with staghorn calculi. Significant chest complications may develop in 5% patients, which required insertion of a chest tube.
it is safe but be aware of the intercostal artery, hydrothorax resolves well after chest tube insertion but hemothorax could be complicated by infection, sepsis and eventually death. The stone free rates varies between 78 and 90%.
Superior calyces should be punctured only under the 11th rib, otherwise the risk of chest complications is >30%, which is unacceptable, according to my point of view
The puncture of the upper calyx not cease to be an experience at high risk of complications, which allows a correct approach to the upper and lower calyx , but now with the use of the flexible uretrocistoscopy , addressing the lower calyx avoids complications
In my experience is usually easy to get to the upper calyx through inferior calyx access even if sometimes I mechanically dilate the infundibulum of the upper calyx. What generally needs a separate puncture is access to the middle calyx.
Puncture the top calyx is associated with more frequent complications compared with other calyxes. The frequency of complications increases 3-5 times and reaches 20-30%.
Superior calyces should be punctured under the 11th rib, complication rate in such cases is much less
such a procedure to an experienced specialist
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