Single-Stage Multiple-Tract Percutaneous Nephrolithotomy in the Treatment of Staghorn Stones under Total Ultrasonography Guidance

Abstract

Objective: To evaluate the safety and efficacy of single-stage multiple-tract percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones solely guided by ultrasonography (US). Patients and Methods: From May 2007 to July 2012, 55 single-stage multiple-tract PCNL procedures were performed (53 patients, of whom 2 had bilateral stones). Caliceal puncture and dilatation were performed under US guidance in all cases. The procedure was evaluated for access success, length of postoperative hospital stay, complications (modified Clavien system), and stone clearance. Results: The mean (±SD) operating time was 84.87 ± 24.9 min, with a mean (±SD) postoperative hospital stay of 5.2 ± 1.31 days. The patients experienced a mean (±SD) decrease in hemoglobin level of 8.23 ± 2.39 g/l and the stone-free rate after single-stage surgery was 78.18%. Extracorporeal shock wave lithotripsy was indicated in 2 cases as an auxiliary treatment. There were 10 grade 1 (62.5%) and 6 grade 2 (37.5%) complications; however, there were no complications above grade 3. Conclusion: Total US-guided single-stage multiple-tract PCNL for treating staghorn calculi in selected cases is safe, feasible, and may be performed with an acceptable morbidity and with the advantage of preventing radiation hazards and damage to adjacent organs.

Multitract percutaneous nephrolithotomy in the management of staghorn stones

“…In our study, we achieved an 85% stone-free rate, which is comparable with other studies (84-89%) [24][25][26].…”

“…Cho et al [23] found that in appropriately chosen patients, a multitract PCNL is safe and efficient. Fei et al [24] achieved a 78% stone-free rate in 55 patients with complete staghorn stones who underwent multitract PCNL. They found multitract PCNL crucial to increase total stone clearance and to reduce reliance on supplemental extracorporeal lithotripsy and/or 2nd look PCNL.…”

Comparing Bleeding Complications of Double and Single Access Totally Tubeless PCNL: Is It Safe to Obtain More Accesses?

“…Recent publication by Wang et al [16] reports successful pultipuncture PNL in a single session by adding miniperc to the first standard access in 58 patients with comparable complication rates. Even such efforts have confirmed the feasibility of multi-access PNL under ultrasonographic guidance [17].…”

Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

“…Multiple studies have demonstrated the feasibility of utilizing ultrasound as an imaging modality during PCNL, operating on mean stone burdens ranging from 2-6 cm, producing a 63 % to 100 % stone-free rate [78][79][80][81][82]. Limitations of using ultrasound as the sole technique for access include the limited use in obese patients, those with full staghorn calculi, and those lacking hydronephrosis, due to reduced visibility.…”