Evidence map›Paper›PMID 41546742›Full record

ArticleWorld journal of urology2026

Who still needs multiple access sites in the era of ECIRS and US-guided supine PCNL?

Ziv Savin, Adam Daniel Geffner, Eve Frangopoulos, Vinay Durbhakula, Linda Dayan Rahmani, Asher Mandel, Aubrey Dibello, Esther Kim, Ali Hamlani, Blair Gallante and 3 more

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In one paragraph

Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Ziv SavinDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA. zivsavin23@gmail.com.
Adam Daniel GeffnerIcahn School of Medicine at Mount Sinai, New York, USA, NY.
Eve FrangopoulosDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Vinay DurbhakulaDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Linda Dayan RahmaniDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Asher MandelDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Aubrey DibelloDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Esther KimIcahn School of Medicine at Mount Sinai, New York, USA, NY.
Ali HamlaniDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Blair GallanteDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Mantu GuptaDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
William M AtallahDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.
Kavita GuptaDepartment of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionMultiaccess PCNL, typically performed for large complex renal stones, is associated with higher complication rates. Newer techniques like ECIRS and US-guided supine PCNL may reduce the need for multiple tracts and related morbidity. This study aims to identify contemporary preoperative predictors for multiple access tracts during ECIRS and US-guided supine PCNL.

methodsWe analyzed our most recent 250 patients undergoing US-guided supine PCNL (and ECIRS when indicated) with at least one year follow-up using logistic regression models and sensitivity analyses to find preoperative factors associated with the likelihood of requiring multiple access tracts.

resultsSeventeen patients (7%) had a multiaccess procedure, with the lower pole as the most common first access site (59%), followed by upper pole (35%) and interpolar (6%). Fourteen patients had two access sites, two had three, and just one had four. On univariable analysis, multiple stones, higher stone burden, upper pole stones, interpolar stones, and a higher Guy's Stone Score were associated with likelihood of requiring multiple accesses. On multivariable analysis, stone burden remained the only significant predictor (OR = 1.038, 95% CI: 1.010-1.066, p = 0.007). A burden > 34.5 mm was found to be the optimal size cutoff. Among 36 full staghorn cases, 6 (17%) required multiple accesses. In non-staghorn patients, upper pole stones were the strongest predictor (OR = 5.056, 95% CI: 1.272-20.099, p = 0.021).

conclusionIn the era of ECIRS, US-guidance, and supine position, only 7% of patients require multiaccess PCNL. Total linear stone burden, upper pole stones and number of calyces are key risk factors, highlighting the value of preoperative identification for optimized surgical planning and outcomes.

Indexed as

Kidney CalculiNephrolithotomy, PercutaneousNephrostomy, PercutaneousPatient PositioningUltrasonography, InterventionalAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesSupine PositionAccess tractECIRSPercutaneous nephrolithotomySupineUltrasound-guided

Identifiers

PMID41546742

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.