Background: Percutaneous nephrolithotomy (PCNL) is established as the standard minimally invasive approach for the management of large and complex renal calculi. The choice between single-tract and multiple-tract access remains debated, with concerns about safety, efcacy, and complication rates. Objective: To compare the safety and efcacy of multiple-tract versus single-tract PCNL in patients with complex renal calculi at a single tertiary care centre. Methods: A retrospective analysis was conducted of 500 adult patients who underwent PCNL between January 2014 and December 2022. Patients were divided into single-tract (n=400) and multiple-tract (n=100) groups. Baseline characteristics, operative parameters, complications, and follow-up outcomes were compared. Statistical analysis was performed using t-test and chi-square tests, with p 2 cm (65% vs 30%, p<0.001). Operative time (108.3 vs 82.5 min, p<0.001), mean blood loss (350 vs 190 mL, p<0.001), and transfusion requirement (15% vs 4.5%, p=0.002) were signicantly higher in the multiple-tract group. The stone-free rate was slightly lower in the multiple-tract group (78% vs 85%, p=0.08). Postoperative complications, including fever (11% vs 5%, p=0.04) and Clavien–Dindo ≥III events (6% vs 2%, p=0.03), were more frequent with multiple tracts. Hospital stay was longer (5.4 vs 3.8 days, p<0.001). On follow-up, re-treatment (8% vs 4%, p=0.04) and renal function deterioration (6% vs 2.5%, p=0.02) were also more common in the multiple-tract group. Conclusion: Multiple-tract PCNL is associated with increased operative time, blood loss, complications, and hospital stay, though it remains an effective strategy for achieving acceptable stone clearance in complex cases. Careful patient selection and surgical planning are essential to optimize outcomes.
Bhatti et al. (Mon,) studied this question.
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