Introduction and Objectives
To investigate the outcome of percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi and to assess whether we can predict the required access number for success or not.
Material and Methods
Between October 2002 and January 2009, the records of 413 patients with staghorn calculi who underwent percutaneous nephrolithotomy were reviewed retrospectively. Of the 413 patients, 223 (54%) had complete and 190 (46%) partial staghorn calculi. Intravenous urography and/or CT were performed in all patients. A total 244 (59%) patients were managed by single access (group 1), and 169 (41%) patients underwent multiple accesses, the number ranging from 2 to 6 (group 2). Both groups were compered in terms of peroperative findings and post-operative outcomes. Patients and stone-related factor affecting the number of accesses performed were analyzed.
Results
The mean number of percutaneous access was 2.42±0.74 (range 2–6) in group 2. Mean duration of floroscopy and operation times were significantly longer in group 2 (p:0.002, p < 0.0001, respectively). Supracostal access was required in 30.7% in group 2, and in 6.9% in group 1 (p = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PNL (p = 0.012). The most common complications were bleeding for both groups and it is higher in group-2 (p < 0.0001). Neither the stone size nor the degree of hydronephrosis could predict the number of accesses but the incidance previous open surgery was higher in group 2 (p:0.008).
Conclusions
PCNL with multiple accesses is a highly successfull alternative with considerable complication rates in the management staghorn calculi. Our results further indicated that only the history of previous open surgery predicted the need for multiple accesses.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
