Percutaneous Nephrolithotomy for Staghorn Calculi with Standard 24 Fr Tract: Feasibility and Clearance
Article Sidebar
Main Article Content
Abstract
Background: Staghorn stones represent branched renal calculi that involve renal pelvis and two or more renal calyces. Various modalities are utilized to treat these complex calculi like PCNL, ECIRS, open surgery, laproscopic/robotic surgery and ESWL. PCNL is considered as the first procedure of the choice to deal with staghorn stones We here discuss our experience of treating staghorn stones in our tertiary centre for past 10 years.
Material and methods: This is a retrospective descriptive type of study done at a tertiary center from August 2013 to July 2022. 253 patients of staghorn calculi underwent PCNL. Pre-operative and post-operative x-ray KUB and USG KUB were done to record the stone status. All complications were recorded as per the Clavien-Dindo grading system. The minimum duration of follow-up in the study is 3 months.
Results: The mean age was 41.51 ± 14.75 years with male to female ratio of 2.41. The size of the staghorn calculi ranged from 38-118 mm with a mean of 58.67 ± 16.21 mm. The hemoglobin fell from 12.4 ± 1.21 g/dL pre-operatively to 10.6 ± 1.43 g/dL, post-operatively. There was a rise of serum creatinine levels from 1.46 ± 0.56 mg/dL pre-operatively to 1.63 ± 0.66 mg/dL in the post-operative period. 41.10% patients had complications ranging from Calvien-Dindo grade I to III. 89.32% cases were rendered stone-free after single session. The success rate at 3 months was 93.67% for complete clearance.
Conclusion: PCNL is a feasible, safe, efficient, and important tool for surgical treatment even with multiple access tracts and remains the gold standard for complex and staghorn renal calculi.
Metrics
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
Nojaba L, Guzman N. StatPearls. Treasure Island, FL: StatPearls Publishing; 2022. Nephrolithiasis.
Guha M, Banerjee H, Mitra P, Das M. The demographic diversity of food intake and prevalence of kidney stone diseases in the Indian continent. Foods. 2019;8:37.
Rieu P: Infective lithiasis. Ann Urol (Paris). 2005; 39: 16-29.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr., et al. Chapter 1: AUA guideline on management of staghorn calculi: Diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
Fink HA, Wilt TJ, Eidman KE et al (2013) Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Int Med 158(7):535–543.
Elawady H, Mostafa DE, Mahmoud MA, Abuelnaga M, Farouk A, Tawfck A, Elzayat T, Ahmed A (2018) Is multiple tracts percutaneous nephrolithotomy (PCNL) safe modality in the management of complex renal stones? A prospective study: a single-center experience. Afr J Urol 24(4):308–314
Otas D, Milenkovic PD, Predrag N, Djordje A, Bojan C, Uros B, Milan R, Aleksandar J, Skolarikos A (2018) Multi-tract percutaneous nephrolithotomy approach. Hellenic Urol 12:30
https://uroweb.org/guidelines/urolithiasis/chapter/guidelines-UROLITHIASIS - LIMITED UPDATE MARCH 2023, page 31.
Clayman RV, Surya V, Miller RP, Casteneda Zunega WR, Amplatz PH, Lange PH. Percutaneous nephrolithotomy; an approach to branched and staghorn renal calculi. JAMA 1983;250:73–5.
Desai M, Jain P, Ganpule A, Sabnis R, Patel S, Shervastav P. Developments in technique and technology: the effect on the results of percutaneous nephrolithotomy for staghorn calculi. BJU Int 2009;104:542–8.
Morris DS, Wei JT, Taub DA, Dunn RL, Wolf Jr JS, Hollenbeck BK. Temporal trends in the use of percutaneous nephrolithotomy. J Urol 2006;175:1731–6.
Aso Omer Rashid, Sarwar Noori Mahmood, Aram Karim Amin2, Rawa Bapir and Noor Buchholz. Multitract percutaneous nephrolithotomy in the management of staghorn stones. Afr J Urol (2020) 26:74.
Soucy F, Ko R, Duvdechai M, Nott L, Denstedt JD, Razvi H. Percutaneous nephrolithotomy for staghorn calculi. A single center experience of 15 years. J Endourol 2009;10:1–5.
Singla M, Srivastava A, Kapoor R, Gupta N, Ansari MS, Dubey D, et al. Aggressive approach to staghorn calculi-safety and efficacy of multiple tracts percutaneous nephrolithotomy. Urology 2008;71:1039-42.
Liatsikos EN, Kapoor R, Lee B, Jabbour M, Barbalias G, Smith AD. “Angular percutaneous renal access”. Multiple tracts through a single incision for staghorn calculous treatment in a single session. Eur Urol 2005;48:832-7.
Ganpule AP, Reddy MN, Sudharsan SB, Shah SB, Sabnis RB, Desai MR. Multitract percutaneous nephrolithotomy in staghorn calculus. Asian J Urol 2020;7:94-101.
Ganpule A, Desai M (2009) Fate of residual stones after percutaneous nephrolithotomy: a critical analysis. J Endourol 23(3):399–403.
Osman Y, El-Tabey N, Refai H, Elnahas A, Shoma A, Eraky I, et al. Detection of residual stones after percutaneous nephrolithotomy: role of non-enhanced spiral computerized tomography. J Urol 2008;179:198–200.
Gupta NK, Huda NA, Pal DK. A comparative study between one step dilatation and serial dilatation technique in percutaneous nephrolithotomy. Urologia Journal. 2024;91(2):332-336.
Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with singletract procedures. J Endourol 2006;20:753-60.
Ahmed R. El-Nahas , Ibrahim Eraky, Ahmed A. Shokeir, Ahmed M. Shoma, Ahmed M. El-Assmy, Nasr A. El-Tabey, Hamdy A. El-Kappany, Mahmoud R. El-Kenawy. Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. Arab Journal of Urology (2012) 10, 324–329.
Zhang FB-Y, Lin W-R, Yang S, et al. Outcomes of percutaneous nephrolithotomy versus open stone surgery for patients with staghorn calculi. Urol Sci 2017; 28: 97–100.