Comparison of standard-percutaneous nephrolithotomy combined ultrasonic lithotripsy system and mini-percutaneous nephrolithotomy combined high-power holmium laser for staghorn calculus: A retrospective comparative study

Abstract

Purpose To compare the outcomes of standard-percutaneous nephrolithotomy combined ultrasonic lithotripsy system(s-PCNL+ULS) and mini-percutaneous nephrolithotomy combined high-power holmium laser(m-PCNL+hHL) for the treatment of staghorn calculus. Methods The data of patients who underwent PCNL for the treatment of staghorn calculus were retrospectively reviewed between 2019 and 2022 from the second hospital of Tianjin medical university. The nephrostomy tracts were dilatated to 24 F in standard PCNL and 16-18 F in mini PCNL, standard PCNL combined ultrasonic lithotripsy system and mini PCNL combined high-power holmium laser. The preoperative, intraoperative, and postoperative variables of the patients were calculated to evaluate the efficacy and reliability of the two groups. Results 1778 patients were received PCNL between 2019 and 2022, After screening computed tomography, finaly 310 patients with staghorn calculus were included. 98 underwent s-PCNL+ULS and 212 underwent m-PCNL+hHL. The total operative time (min) ,haemoglobin deficit (ΔHGB (g/L)) ,the postoperative hospitalization days for s-PCNL+ULS and m-PCNL+hHL groups were 76.07±26.68 vs 103.93±24.84(P＜0.001), 9.30±9.26 VS 7.73±7.50(P=0.017); 7.32±5.14 VS 4.71±2.42(P＜0.001). The incidence complications for s-PCNL+ULS and m-PCNL+hHL groups were 28.57% vs 16.04%(P = 0.064), s-PCNL+ULS group had more severity complications (9.18% vs 2.83%, P = 0.022) . The firist and second stone-free rates of PCNL were 56.12% VS 57.08%(P=0.902) and 92.86% VS 86.32%(P=0.126) for the m-PCNL+hHL and s-PCNL+ULS groups. Conclusion The efficacy of m-PCNL+hHL was comparable to s-PCNL+ULS in the treatment of staghorn calculus. The advantages of m-PCNL+hHL included the lower haemoglobin deficit, shorter hospital stay and lesser severity complications.