Is Lower Pole Access Safer for Ultrasound-Guided Supine Percutaneous Nephrolithotomy?

INTRODUCTION: Ultrasound (US)-guided supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. The aim of this study was to assess the safety of lower vs non-lower pole access (non-LPa) in supine US-guided PCNL. METHODS: This study was a retrospective cohort analysis of 228 patients who underwent single-access US-guided supine PCNL between March 2023 and June 2024 and were categorized into lower (n = 162), interpolar (n = 42), and upper pole (n = 21) access categories. Baseline demographics, stone characteristics, and intraoperative details were analyzed and compared between the groups. Safety outcomes, including 30-day postoperative total and major complications (based on Clavien-Dindo classification), as well as pain scores, were compared between lower pole access (LPa) and non-LPa. RESULTS: = .05). There were 2 visceral injuries in the interpolar group. Visual analogue scale pain scores at the recovery room were not different between the groups. CONCLUSIONS: When performing US-guided supine PCNL, LPa has a superior safety profile, resulting in fewer major and total complications compared with non-LPa.