PCNL in Staghorn Calculi: Our Experience

Abstract

Background:The treatment of STAG HORN calculi has varied from combination of percutaneous nephrolithotomy (PCNL) and shockwave lithotripsy (SWL) or sometimes open surgery. The goals of treatment of a STAG HORN stone are complete stone clearance with minimal morbidity. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. Subjects and Methods: From January 2015 to December 2018, 1400 patients underwent PCNL out of which 392 patients had stag horn stones. Our study included stag horn stones that were present in the renal pelvis and branched into two or more major calyces. All procedures were performed under general or spinal anesthesia by the same surgical team. Results: 392 patients (144 women and 248 men) with mean age of 44.2 (range 8yr-72yr) years having partial/complete STAG HORN calculi were treated at our center S.P. Medical college, Bikaner from period of January 2015 to December 2018. 10 patients (10.2%) had pre existing renal insufficiency with a mean (range) serum creatinine of 3.0 (1.5-4.2) mg/dl. Conclusion: PCNL using multiple tracts is safe and effective and should be the first option for renal STAG HORN calculi. It must be done by experienced endourologists in a specialized centre with all the facilities for stone management and treatment of possible complications.