Vol. 6, Issue 1, Part C (2024)

A prospective study conducted at Dhaka Medical College Hospital over 12 months aimed to evaluate the efficacy and safety of middle and lower calyceal access during percutaneous nephrolithotomy (PCNL) for renal pelvis stones. Seventy patients meeting inclusion and exclusion criteria were purposively selected and divided into two groups: Group 1 underwent PCNL via middle calyceal access, and Group 2 via lower calyceal access. Data on clinical history, physical examination, and procedure-related parameters were collected, analyzed using SPSS version 24, and presented in tables and graphs. Both groups had no significant differences in age, sex, or stone size. However, significant differences were observed in procedure-related metrics, including shorter access duration (p=0.01), reduced operative time (p=0.019), lesser hemoglobin drop (p<0.0001), and lower blood transfusion rates (p<0.0001) in the middle calyceal group. Although postoperative parameters such as stone clearance rate (94.3% vs. 85.7%), hematuria (11.4% vs. 17.1%), and postoperative fever (14.3% vs. 17.1%) favored middle calyceal access, these differences were not statistically significant. Overall, the findings suggest that middle calyceal access provides procedural advantages, including reduced operative time, minimized blood loss, and higher stone clearance rates, compared to lower calyceal access during PCNL.