Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years
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Published on: September 13, 2022
Frédéric Soucy1, Raymond Ko, Mordechai Duvdevani
1Department of Surgery, The University of Western Ontario, London, Ontario, Canada .
Insights
Percutaneous nephrolithotomy (PCNL) effectively treats staghorn calculi with low complication rates, achieving high stone-free rates. This study confirms PCNL
Area of Science:
- Endourology
- Nephrolithiasis Management
- Urologic Surgery
Background:
- Staghorn calculi present a complex challenge in endourologic procedures.
- Percutaneous nephrolithotomy (PCNL) offers excellent stone-free rates but variable complication rates, particularly for blood transfusions.
- This study evaluates PCNL outcomes for staghorn calculi at a high-volume, tertiary referral center.
Purpose of the Study:
- To assess the safety and efficacy of PCNL in managing staghorn calculi.
- To analyze complication rates, including blood transfusions, associated with PCNL for staghorn calculi.
- To determine stone-free rates following PCNL for staghorn calculi.
Main Methods:
- A retrospective analysis of 509 PCNL procedures for staghorn calculi performed between July 1990 and December 2005.
- Data collected included procedure time, hospital stay, number of access tracts, transfusion rates, and stone-free status.
- Patients were treated using various intracorporeal lithotriptors.
Main Results:
- The mean procedure time was 104 minutes, with 16% requiring multiple access tracts.
- The overall transfusion rate was 0.8%, with no significant difference between single and multiple tract approaches.
- Stone-free rates were 78% at discharge and 91% at 3-month follow-up.
Conclusions:
- PCNL is a safe and effective treatment for staghorn calculi, comparable to non-staghorn stone management.
- Meticulous tract selection and the availability of diverse endourologic equipment are crucial for optimal outcomes.
- PCNL achieves high stone-free rates with acceptable complication profiles in complex staghorn calculi cases.
Background And Purpose:
Percutaneous nephrolithotomy (PCNL) for staghorn calculi is one of the more challenging endourologic procedures. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. The purpose of this study was to evaluate the outcomes of PCNL for patients with staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center.
Patients And Methods:
Between July 1990 and December 2005, 1338 patients underwent PCNL for renal stone disease at our institution. Among this group, 509 procedures were performed for patients with a partial or complete staghorn calculus. Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other early and late complications, and stone-free status.
Results:
Mean patient age was 53.8 years (range 4-84 yrs). The average procedure time was 104 minutes. Sixteen percent of the cases needed multiple access tracts (range 2-5), with the lower calix being the most commonly used in 64.1%, followed by the upper calix in 18.5% and the middle calix in 17.4%. Various intracorporeal lithotriptors were used, including ultrasound, pneumatic, electrohydraulic, and holmium:yttrium-aluminium-garnet laser. The transfusion rate among this group was 0.8%. There was no statistically significant difference in transfusion rates (0.7%-1.2% P = 0.24) or other major complications in patients who were treated with either a single tract or among those needing multiple tracts. Stone-free rates at hospital discharge and at 3 months follow-up were 78% and 91%, respectively.
Conclusion:
PCNL is a safe and effective procedure in the management of staghorn calculi, with outcomes similar to those reported for percutaneous management of smaller volume nonstaghorn stones. Attention to accurate tract selection and placement as well as possession of the full array of endourologic equipment are essential to achieving an excellent outcome.
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