Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Complete staghorn calculi often require combination therapy (percutaneous nephrolithotomy [PCNL] and shockwave lithotripsy [SWL]) or open surgery.
• Urologists often limit PCNL tracts due to concerns about increased complications.
• This study investigates the efficacy of multi-tract PCNL for large staghorn calculi (surface area >3,000 mm²).

Purpose of the Study:

• To evaluate the safety and effectiveness of multi-tract PCNL for treating large complete staghorn calculi.
• To challenge the notion that multiple PCNL tracts increase complications.
• To support aggressive PCNL monotherapy as a primary treatment option.

Main Methods:

• A retrospective analysis of 121 renal units (103 patients) treated with PCNL between July 1998 and October 2003.
• Procedures performed in the prone position with fluoroscopic guidance and retrograde ureteral catheterization.
• Multiple tracts (up to 5) were utilized, with stones fragmented and removed via pneumatic lithotripsy and suction.

Main Results:

• 121 renal units with staghorn calculi (mean surface area 4,800 mm²) were treated using 397 tracts across 140 procedures.
• Complications included blood transfusion (18%), fever (22%), and septic shock (1%).
• PCNL monotherapy achieved an 84% complete clearance rate, improving to 94% with adjunctive SWL in select cases.

Conclusions:

• Aggressive PCNL monotherapy utilizing multiple tracts is safe and effective for massive renal staghorn calculi.
• This approach should be considered the first-line treatment for such complex stone burdens.
• Multi-tract PCNL offers a high stone-free rate, potentially reducing the need for secondary procedures.