Comparative study of percutaneous access for staghorn calculi

Area of Science:

• Nephrology
• Urology
• Minimally Invasive Surgery

Background:

• Staghorn calculi present a complex treatment challenge in urology.
• Percutaneous nephrolithotomy (PCNL) is a primary treatment modality for large renal stones.
• Optimal access strategy is crucial for PCNL success in staghorn calculi.

Purpose of the Study:

• To compare the efficacy and safety of PCNL for staghorn calculi based on renal access site.
• To evaluate success rates and complication profiles associated with upper pole, lower/middle calix, and multiple access routes.

Main Methods:

• Retrospective review of 119 patients undergoing PCNL for staghorn calculi (January 1995 - December 2000).
• Analysis of stone-free rates, operative times, and complication incidence stratified by access approach (upper pole, lower/middle calix, multiple access).
• Mean stone burden was 6.9 cm, with 27.7% of patients requiring multiple access tracts.

Main Results:

• Stone-free rates were high across all groups: 87.5% (upper pole), 80.0% (lower/middle), and 84.8% (multiple access).
• The multiple access group experienced a higher rate of bleeding requiring transfusion (45.4% complications).
• Overall complication rates were 25% (upper pole), 21.4% (lower/middle), and 45.4% (multiple access), with thoracic complications in 1.7%.

Conclusions:

• Successful percutaneous treatment of staghorn calculi is strongly linked to the chosen kidney access.
• Supracostal and multiple access techniques are viable options, associated with a manageable increase in complications.
• Careful selection of access site optimizes outcomes for PCNL in staghorn calculus management.