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[Clinical analysis of percutaneous nephrolithotomy for staghorn calculi with different stone branch number]
Shi-yong Qi1, Zhi-hong Zhang1, Chang-wen Zhang1
1Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China.
Insights
Staghorn kidney stones with more than 5 branches require more complex percutaneous nephrolithotomy (PNL) procedures, often needing multiple tracts or stages. These complex cases result in longer operative times, increased hospital stays, and lower stone clearance rates.
Area of Science:
- Urology
- Nephrolithiasis Research
- Surgical Outcomes Analysis
Context:
- Staghorn calculi present a significant challenge in urological stone management.
- Percutaneous nephrolithotomy (PNL) is a primary treatment modality for complex kidney stones.
- The anatomical complexity of staghorn stones, particularly their branching, influences PNL outcomes.
Purpose:
- To evaluate the correlation between the number of staghorn stone branches and the outcomes of percutaneous nephrolithotomy (PNL).
- To determine if increased stone branching impacts operative time, stone clearance, and postoperative recovery.
Summary:
- A study of 371 patients undergoing PNL for staghorn calculi analyzed outcomes based on stone branch number, using CT 3-dimensional reconstruction.
- Patients with staghorn stones having 5 or more branches showed a significantly higher need for multi-tract and staged PNL.
- These complex cases were associated with longer operative times, extended hospital stays, and reduced stone-free rates compared to simpler staghorn calculi.
Impact:
- Findings suggest that a higher number of stone branches (≥5) is a predictor of more challenging PNL procedures.
- This research aids in pre-operative planning and patient counseling for staghorn calculi treated with PNL.
- Optimizing surgical strategies based on stone complexity can improve PNL efficacy and patient outcomes.
Objective:
To investigate the impact of staghorn stone branch number on outcomes of percutaneous nephrolithotomy (PNL).
Methods:
From January 2009 to January 2013, the 371 patients with staghorn stones who were referred to our hospital for PNL were considered for this study. All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging. The computerized database of the patients had been reviewed. Our exclusion criterion was patients with congenital renal anomalies, such as horse-shoe and ectopic kidneys. And borderline stones that branched to one major calyx only were also not included. From 3-DR images, the number of stone branching into minor renal calices was recorded. We made "3" as the branch breakdown between groups. And the patients were divided into four groups. The number of percutaneous tract, operative time, staged PNL, intra-operative blood loss, complications, stone clearance rate, and postoperative hospital day were compared.
Results:
The 371 patients (386 renal units) underwent PNL successfully, included 144 single-tract PNL, 242 multi-tract PNL, 97 staged PNL. The average operative time was (100 ± 50) minutes; the average intra-operative blood loss was (83 ± 67) ml. The stone clearance rate were 61.7% (3 days) and 79.5% (3 months). The postoperative hospital stay was (6.9 ± 3.4) days. A significantly higher ratio of multi-tract (χ(2) = 212.220, P < 0.01) and staged PNL (χ(2) = 49.679, P < 0.01), longer operative time (F = 4.652, P < 0.01) and postoperative hospital day (F = 2.067, P = 0.043) and lower rate of stone clearance (χ(2) = 10.691 and 47.369, P < 0.05) were found in PNL for calculi with stone branch number ≥ 5. There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P = 0.460).
Conclusion:
The possibility of multi-tract and staged PNL, lower rate of stone clearance and longer postoperative hospital day increase for staghorn calculi with stone branch number more than 5.
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