Percutaneous treatment of staghorn stones: a retrospective case-control study with evaluation of single vs multiple access to the kidney

Staghorn stones have been treated, up to 30 years ago, with open surgery. With the introduction of percutaneous procedure (PNL) and the use of shock wave lithotripsy (SWL) together with flexible instrumentation and Holmium Laser lithotripsy the indication for open surgery is actually very limited. On the other hand conservative treatment of staghorn calculi will result in a complete destruction of the kidney associated to a mortality rate up to 30%. The best results of surgical treatment have been obtained after anatrophic nephrolithotomy, with stone-free rates of 71 to 100%. In 1955 was first described the method of percutaneous nephrostomy insertion, and 20 years later was first reported on percutaneous nephrostolithotomy. Initially, only calculi no larger than the diameter of the nephrostomy tract were removed. Treatment of complex staghorn stones remained controversial because of the very high stone burden and it was also debated the choice between a single tract percutaneous approach, or a multiple tract approach in order to obtain a complete stone clearance. In our study we have compared the percutaneous approach with a single tract and the use of a flexible nephroscope in order to reach all the calices with the percutaneous approach with multiple accesses.