The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome

Abstract

The objective of this study was to analyze the outcome of percutaneous nephrolithotomy (PCNL), laparoscopic and open anatrophic nephrolithotomy (AN) for management of patients with large staghorn renal stones. We analyzed the peri-operative parameters, overall treatment costs and changes in the function of the affected kidney on technetium-99 dimercaptosuccinic acid renal scintigraphy, done before the operation and before the final follow-up visit, in 45 adults who underwent PCNL (n = 16) versus laparoscopic (n = 15) versus open (n = 14) AN for large staghorn renal stones. All three groups had statistically similar preoperative characteristics, including the function of the operated kidney on renal scan. On the discharge day, the PCNL group had the lowest stone-free rate (43.75 %) compared to the laparoscopic (80 %) and open AN groups (92.85 %) (P = 0.009). After a mean follow-up period of 12.1 months, the decrease in the function of the operated kidney was greatest in the open AN group (-8.66 ± 4.97) compared to the laparoscopic AN (-6.04 ± 6.52) and PCNL group (-2.12 ± 2.77) (P = 0.003). The need for ancillary procedures to manage residual stones was greatest in the PCNL group and lowest in the open AN group. A similar trend was seen in overall treatment costs (P < 0.001). For management of large staghorn renal stones, the more invasive the procedure, the higher the one-session stone-free rate and the lower the need for ancillary procedures; however, greater renal functional loss can be anticipated. The need for ancillary procedures is a major determining factor in the overall cost of treatment, which was highest in the PCNL group.

Management of upper urinary tract calculi in crossed fused renal ectopic anomaly

“…For large calculus or staghorn renal stones, PCNL may not be as effective as previously believed. A recent study reported that the more invasive the chosen procedure, the higher the one-stage stone-free rate, the lower the need for ancillary procedures and the lower the cost of hospitalization (24). A study by Mishra et al (7) reported a 68-year-old female with a staghorn stone in her right ectopic kidney, for whom a residual stone remained following two PCNL treatments.…”

Impact of nursing interventions and patients education on quality of life regarding renal stones treated by percutaneous nephrolithotomy

“…[18] This variability is most probably due to the lack of a uniform system for the definition and the assessment of these complications and due to the different ways of display. Some report only urinary complications some include extra-urinary complications and others divide complications into minor and major ones.…”

Heart of Darkness

“…A more recent publication by Aminsharifi et al 14 compared 45 adults who underwent PCNL, 16 OS, 14 or LS 15 between 2010 and 2015.…”