Standard percutaneous nephrolithotomy alone versus in combination with intraoperative anterograde flexible nephroscopy for staghorn stones: A retrospective study

Abstract

This study aimed to compare the outcomes of standard percutaneous nephrolithotomy (PCNL) to PCNL with intraoperative antegrade flexible nephroscopy (IAFN) for treating stones of staghorn nature. We retrospectively analyzed patients treated using PCNL between January 2007 and July 2013. A total of 1250 patients were treated using PCNL, and 166 patients had staghorn stones. All patients had been subjected to a complete blood count, routine biochemical analyses, coagulation tests, a complete urine analysis, and urine cultures. Patients with a positive urine culture had been treated with appropriate antibiotics until the urine culture became negative. After purchasing a flexible renoscope in March 2012, we routinely used this tool to improve the stone-free (SF) rate. The 105 patients who underwent standard PCNL prior to March 2012 were classified as Group 1, and the 61 patients who underwent PCNL + IAFN after that date were classified as Group 2. The two groups had similar and homogeneous demographic data. The fluoroscopy and total operative times were significantly higher in Group 2 than in Group 1 (p < 0.01). Additionally, the hospitalization time (p < 0.01) and the mean hematocrit decrease (p < 0.01) were significantly lower in Group 1. In both groups, the SF rates were higher than 85%, similar to those reported in the literature. Although Group 2 had a slightly better SF rates, this difference was not statistically significant. For staghorn calculi, PCNL combined with IAFN yields excellent outcomes. However, similar prospective studies on larger cohorts should be performed to support our findings.

Treatment of Complex Renal Calculi by Digital Flexible Ureterorenoscopy Combined with Single-Tract Super-Mini Percutaneous Nephrolithotomy in Prone Position: A Retrospective Cohort Study

“…In pediatric patients, this achieved a stone-free rate of 87% in these difficult-to-treat cases because of the small size of the calyx [17], and in adult patients there was a 92% stone-free rate compared to 80% in patients treated with flexible URS alone [18]. Large stones treated in adults achieved a 81.7% stone-free rate versus 38.9% for mini-PCNL alone [19]; however, the stone-free rates for staghorn stones were similarly high, above 85%, for patients treated with PCNL alone and PCNL and flexible URS in combination, and the combination treatment was longer, with a longer hospitalization time, but this method used traditional PCNL [20]. Other combined methods that used some form of miniaturized PCNL showed shorter operation times than the isolated procedures [18,19].…”

“…However, these techniques cannot resolve all cases with multiple kidney stones, resulting in a low stone-free rate and complications in some patients [12,14]. Previous reports have demonstrated that miniaturized PCNL combined with digital flexible URS is safe for pediatric [17] and adult patients [18] with multiple kidney stones and for adults with large stones [19,20]. The combination of SMP and flexible URS means the entire procedure from puncture to PCNL can be constantly monitored and limits the size and number of tracts during PCNL.…”

“…The combination of SMP and flexible URS means the entire procedure from puncture to PCNL can be constantly monitored and limits the size and number of tracts during PCNL. However, there have been few studies on the use of miniaturized PCNL combined with flexible URS in the treatment of large stones and multiple kidney stones [17–20]. Further information is needed to support the use of this technique in suitable patient populations.…”

Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years’ experience

“…Stone free rate was 87% with flexible nephroscopy vs. 81% without it. 13 In a similar study by Desai et al, a retrospective analysis of 684 patients who underwent PCNL with multiple tracts or PCNL with flexible nephroscopy through single tract. They found no difference in stone free rate among both groups.…”

“…They had mean operating time of 95 and 113 minutes for standard PCNL and PCNL with flexible nephroscopy respectively. 13 …”