Percutaneous Nephrolithotomy for Staghorn Calculi: A Single Center's Experience over 15 Years

Soucy, Frédéric; Ko, Raymond; Duvdevani, Mordechai; Nott, Linda; Denstedt, John D.; Razvi, Hassan

doi:10.1089/end.2009.1534

Cited by 103 publications

(63 citation statements)

References 15 publications

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“…They included subject criteria similar to our study, namely the complete and partial staghorn calculi 14 . However, the stone-free rate of our study was lower than that reported by Soucy et al 13 who reported higher stone-free rate (78%). That study incorporated branched stone in just one calyx (borderline staghorn calculi) found in 67% of their patients, so that the majority of patients had a lower burden stone and were easier to treat 13 .…”

Section: Discussioncontrasting

confidence: 89%

“…The goal treatment of staghorn calculi is stone-free thoroughly with minimal morbidity 1, 11 . PCNL in patients with staghorn calculi still represents a procedural challenge, thus requiring the surgeon to perform complete removal of the stone while keeping morbidity to a minimum 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Stone-free rate after PCNL monotherapy for staghorn calculi is reported to range between 49% to 78% 13 . In this study, the stone-free rate after PCNL monotherapy was 64.6%.…”

Section: Discussionmentioning

confidence: 99%

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Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

2016

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Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

2016

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“…Regarding the stone clearance rate, Falahatkar et al in their series, they achieved 87.5% stone clearance rate, Soucy et al report 91% stone clearance rate at three months follow up for partial or complete staghorn stones using single or multiple tracts. 25 Our study revealed 97% stone clearance rate and 3% with clinically insignificant fragments following PCNL monotherapy compares favorably with the results ofothers. [26][27][28] PCNL is a safe and effective method of stone removal in patients with calculi in horseshoe kidneys.…”

Section: Discussionsupporting

confidence: 82%

Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College

Sapkota¹,

Tambey²,

Thapa³

et al. 2013

J Lumbini Med Coll

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ABSTRACT:Introduction: Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. Since ,the early 1980s when percutaneous nephrolithotomy (PCNL) was established for management of renal stones, open surgical procedures have virtually been replaced. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones. The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones. Methods: Prospective study carried out at Lumbini Medical College and Teaching Hospital during 1stJanuary 2011 to 31st October 2011. Sixty patients were evaluated and subjected to PCNL. After clinical investigations like ultrasonography (USG) and intravenous urography (IVU), once patients were found to have renal or upper ureteric stones they were informed and explained about PCNL, its likely complications, probable hospital stay, the cost of treatment and data were recorded along with the operative time, estimated blood loss, stone burden, stone-free rate, length of hospitalization and complications .Patients were followed up after three months to rule out recurrence of stones by plain abdominal x-ray of kidney, ureter and bladder and USG. Results: Out of 60 patients 35 were male and 25 were female (M: F=1.4:1) with mean age of 37 years and were subjected to PCNL monotherapy. With the average stone size of 3.26cm, the mean operative time was 78 minutes. Complete stone removal achieved by PCNL alone in 60 cases, with insignificant residual small stones we achieved 97% stone clearance rate. The mean hospital stay was 3.7 days. No Serious complications were encountered, 9 (15%) patients required blood transfusion and 3 (5%) patients developed transient post-operative pyrexia. Conclusion: PCNL is the first line treatment option for management of large renal stones which as monotherapy has advantages in removal of renal and upper ureteric stones and achieving excellent results with minimal morbidity.

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“…Staghorn calculi may not always be investigated for underlying cystinuria, because it may be falsely assumed that they are infective stones, struvite in origin, and composed of magnesium ammonium phosphate. Case series reported by Soucy et al (26) and Viprakasit et al (27) have shown that between 21% and 44% of staghorn calculi are struvite, and for the remainder, other etiogic causes should be sought. Cystinuria is a known and important cause of staghorn calculi.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Genetic Analysis of Patients with Cystinuria in the United Kingdom

Rhodes

Yarram-Smith²,

Rice

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cystinuria is a rare inherited renal stone disease. Mutations in the amino acid exchanger System b 0,+ , the two subunits of which are encoded by SLC3A1 and SLC7A9, predominantly underlie this disease. The work analyzed the epidemiology of cystinuria and the influence of mutations in these two genes on disease severity in a United Kingdom cohort.Design, setting, participants, & measurements Prevalent patients were studied from 2012 to 2014 in the northeast and southwest of the United Kingdom. Clinical phenotypes were defined, and genetic analysis of SLC3A1 and SLC7A9 combining Sanger sequencing and multiplex ligation probe-dependent amplification was performed.Results In total, 76 patients (42 men and 34 women) were studied. All subjects had proven cystine stones. Median age of presentation (first stone episode) was 24 years old, but 21% of patients presented after 40 years old. Patients had varied clinical courses, with 37% of patients having $10 stone episodes; 70% had evidence of CKD, and 9% had reached ESRD as a result of cystinuria and its complications. Patients with cystinuria received a variety of different therapies, with no obvious treatment consensus. Notably, 20% of patients had staghorn calculi, with associated impaired renal function in 80% of these patients. Genetic analysis revealed that biallelic mutations were present in either SLC3A1 (n=27) or SLC7A9 (n=20); 22 patients had only one mutated allele detected (SLC3A1 in five patients and SLC7A9 in 17 patients). In total, 37 different mutant variant alleles were identified, including 12 novel mutations; 22% of mutations were caused by large gene rearrangements. No genotypephenotype association was detected in this cohort.Conclusions Patients with cystinuria in the United Kingdom often present atypically with staghorn calculi at $40 years old and commonly develop significant renal impairment. There is no association of clinical course with genotype. Treatments directed toward reducing stone burden need to be rationalized and developed to optimize patient care.

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Percutaneous Nephrolithotomy for Staghorn Calculi: A Single Center's Experience over 15 Years

Cited by 103 publications

References 15 publications

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College

Clinical and Genetic Analysis of Patients with Cystinuria in the United Kingdom

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