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Percutaneous nephrolithotomy for large and staghorn calculi
1University Department of Urology at the JJ Group of Hospital, Bombay, India.
Journal of Endourology
|August 1, 1993
Summary
Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large kidney stones (>3 cm), including staghorn calculi, offering a 93% clearance rate. This method is superior to extracorporeal shock wave lithotripsy (SWL) for complex cases.
Area of Science:
- Urology
- Nephrology
Background:
- Extracorporeal shock wave lithotripsy (SWL) is standard for stones up to 3 cm.
- Treatment choice for larger stones and staghorn calculi remains debated.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for large renal calculi (>3 cm).
Main Methods:
- Retrospective analysis of 878 renal units treated with PCNL over 9 years for stones >3 cm.
- Assessment of complete stone clearance rates and complication incidence.
Main Results:
- Overall complete stone clearance rate of 93% achieved with PCNL.
- Clearance rates varied: 98.5% for solitary calculi, 71% for complete staghorn calculi.
- Acceptably low complication rate of 4%.
Conclusions:
- PCNL is the preferred option for large renal calculi and staghorn calculi, offering superior stone-free rates compared to SWL monotherapy.
- The benefits of PCNL's expeditiousness and higher clearance rates justify its slightly higher morbidity.
- Aim for complete percutaneous clearance, reserving SWL for residual stones.