Introduction and Objectives
The problem of selecting a method in renal staghorn calculus treatment so as to provide the best results for patients is of great importance. There are several approved methods of staghorn stone crushing, such as PCNL, ESWL and URS with holmium laser and traditional open surgery. The selection depends on many essential factors.
Material and Methods
The treatment methods of consecutive 43 patients who were treated due to renal staghorn calculi from April 2004 to May 2005 in the E. Michałowski's Hospital in Katowice were analysed. 41 patients had PCNL as a main method and, when the need appeared, further stages with various techniques: another PCNL, URS, D-J catheter kidney intubation, in order to evacuate all the stones from the kidney. Two patients had classical operations due to complications caused by other disorders: anatomical anomaly (horseshoe kidney) and active lupus erythematosus and further additional procedures necessary to total stone removal.
Results
All patients achieved total recovery from the staghorn calculus. The aim of our analysis was to determine what investment of skills and equipment was needed to achieve the therapeutic success. In group I: (boarder stone fills renal pelvis or renal pelvis and part of one calyx) 7 patients achieved full recovery after 8 procedures (one patients had an additional kidney intubation with D-J catheter). In group II: (partial staghorn stone fills renal pelvis and two calyxes) 18 patients had 31 procedures (PCNL, EWSL+D-J) and in group III (total calculus – the stone fills all the pelvacalyceal system) 21 patients had 53 procedures. In the group of patients with complications caused by other disorders, surgical operation as a monotherapy did not remove all the stone – they required 8 or 5 procedures.
Conclusions
The treatment of renal staghorn calculi should be done by endoscopy in several stages. Traditional treatment with open surgery does not ensure a removal of all the stone, so the combined therapy consisting of other procedures, including endoscopy, must be applied. Renal staghorn calculus is a difficult urological problem and requires individual financing including expenses of multi-stage treatment.
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© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
