Breaking Down Barriers in Staghorn Stone Treatment: Does Upper Pole Access Hold the Key to Superior PCNL Outcomes?

Background: The treatment of staghorn stones via percutaneous nephrolithotomy (PCNL) can involve either upper-pole (UP) or non-upper-pole (NP) access. The UP approach offers better access to the collecting system, which may improve stone clearance but poses a higher risk of complications such as pleural injury and increased blood loss. The NP approach generally has a lower complication rate but may be less effective in achieving complete stone clearance. This study aims to compare outcomes and safety profiles of UP versus NP approaches in PCNL for staghorn stones. Methods: A retrospective cohort study was conducted, reviewing records of 678 patients with staghorn stones who underwent single-puncture PCNL at the Urology Department, B.J. Medical College, Ahmedabad, from March 2022 to March 2024. Patients were categorized into UP (264 cases) and NP (414 cases) groups. Outcomes assessed included stone-free rate, complication rates, operative time, blood loss, and hospital stay. Data were analyzed using descriptive statistics and chi-square tests. Results: Among the 678 patients, the stone-free rate was 88.3% for the UP approach and 79.1% for the NP approach (p=0.008). Thoracic complications, including pleural injury, were higher in the UP group, with a rate of 3.4% compared to 0.9% in the NP group (p<0.001). Blood transfusion was more frequently required in the UP group, and hospital stay duration was longer (4.8 ± 1.2 days vs. 3.6 ± 1.0 days, p<0.001). Postoperative pain scores were also higher for UP on the first and third postoperative days (p<0.05). Conclusions: The UP approach in PCNL for staghorn stones offers a higher stone-free rate but is associated with increased complication risks, such as pleural injury and extended Key words: staghorn, PCNL, upper-pole, non-upper-pole, Urology, complications, stone