[Modified percutaneous nephrolithotripsy as monotherapy in stag-horn nephrolithiasis with complex stereometric...

Percutaneous nephrolithotripsy (PN) was used as monotherapy in modification with one additional nephroscopic approach in surgical treatment of 57 patients suffering from stag-horn nephroliths with complicated stereometric configuration. According to classification of stag-horn concrements, C3 and C4 groups comprised 36 (63.1%) and 21 (36.9%) patients, respectively. The greater part of the stone was removed through a standard percutaneous approach regarding the angle of a rigid nephroscope, the other part of the concrement was evacuated through an additional transcutaneous approach for a small-diameter nephroscope. A mean duration of the operation was 60-150 min. The internal stent-catheter was not installed. Residual concrements were detected in 2 (5.6%) and 4 (19%) cases, in C3 and C4, respectively. The presence of residual fragments is explained by complicated stereometric configuration, high density of the concrements, technical difficulties in surgical intervention. As in such cases residual fragments were clinically significant, they were destroyed ub fragments and eliminated according to the "second look" technique in early postoperative period (day 3-4) through nephrostomic fistulas. All the patients were discharged from the hospital in satisfactory condition on postoperative day 5-9. This modification has advantages: one-stage removal of the stone, low invasiveness and traumatism.