Introduction and Objectives
Although in the last 20 years the incidence of staghorn lithiasis in Romania decreased, especially because of a higher addressability of the patients, which allowed their cure in early stages, its treatment still represents a provocation for urologists. PNL, as unique method or in association with ESWL represents the most efficient treatment for the staghorn calculi.
Material and Methods
Between January 1994 – December 2008, 673 patients (411 men and 262 women), diagnosed with staghorn lithiasis were treated using PNL (in total 1055 procedures). The mean age was 43.4 (age between 24–67 years). 107 of the patients had bilateral staghorn lithiasis. In all the cases, the punction was made under X-ray control. For dilatation we used Alken dilatators and the Amplatz sheath was used in most of the cases (95%). For fragmentation we used ballistic and ultrasonic lithotripsy.
Results
The total success rate was 93.46%. In 391 cases the stone free status was achieved after a single procedure, 203 after 2 procedures, 58 after 3 procedures and 21 respectively 4 procedures. The complications rate was 11.58%. The most frequent were the infectious complications, followed by hemorrhagic complications (in 26 cases surgical treatment having been needed – 18 nephrectomies and 8 selective angiography with embolization). The urinary fistulae were present in 24 cases, being solved by JJ catheterization. The death rate was 1.04%. The death causes were: 3 – coronarian ischemia, 2 – stroke, 2 – sepsis.
Conclusions
We consider that PNL is the gold standard treatment method for staghorn lithiasis, by achieving the stone free status very quickly. Even if the complications rate is higher, their correct management assures the complete recovery of the patients.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
