Treatment of Complete Staghorn Stones: A Prospective Randomized Comparison of Open Surgery Versus Percutaneous Nephrolithotomy

Alkohlany, Khaled; Shokeir, Ahmed A.; Mosbah, Ahmed; Mohsen, Tarek; Shoma, Ahmed M.; Eraky, Ibrahim; El-Kenawy, Mahmoud R.; El‐Kappany, Hamdy A.

doi:10.1097/01.ju.0000150519.49495.88

Cited by 179 publications

(116 citation statements)

References 20 publications

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“…In this study, the stone-free rate after PCNL monotherapy was 64.6%. This is higher than the stone-free rate reported by Al - Kohlany et al (49%) 8 because they only considered and treated complete staghorn calculi, whereas in this study we included both patients with partial staghorn calculi and complete staghorn calculi and we made no distinction between partial and complete staghorn calculi. Stone-free rate in our study was not very different from the research conducted by El-Nahas et al 14 (56.6%) and Desai et al 9 (56.9%).…”

Section: Discussionmentioning

confidence: 61%

“…Percutaneous nephrolithotomy (PCNL) has become the recommended treatment for staghorn calculi as it has stone-free rate three times higher than extracorporeal shock wave lithotripsy (ESWL) and has lower morbidity, shorter length of hospital stay, shorter operating time, and time to return to work faster than open surgery 1, 8 . Nevertheless, the management of staghorn calculi with PCNL remains challenging.…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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

2016

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“…The stone clearance rate described in literature in a series of 26 cases from the Armed forces Hospital, Muscat [5] in which this procedure was done was around 85-88%. Another series comparing the results of PCNL and Open surgery had a stone clearance rate of 82% in 45 cases for whom open surgery was done for complete staghorn calculus [8]. We had complete stone clearance in 7 out of the 9 cases as demonstrated by X-ray and Ultrasound.…”

Section: Discussionmentioning

confidence: 94%

Modified Anatrophic Nephrolithotomy "A Salalah Experience"

Dhinakar¹

2014

UNOAJ

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“…In past practice, large renal calculi required open renal surgery (1). Extracorporeal shockwave lithotripsy (ESWL) for large stone burden is not recommended.…”

Section: Introductionmentioning

confidence: 99%

A novel endoscopic treatment for renal arteriopelvic fistula post-percutaneous nephrolithotomy (PCNL)

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________ Main findings:We describe the use of a novel endoscopic approach in the management of unremitting gross hematuria following post-percutaneous nephrolithotomy (PCNL) in a 65-years-old male. This approach proved successful and cost-effective in managing haemorrhage post-PCNL when renal angiography failed to localize the source of bleeding.Case hypothesis: The recommended treatment modality for renal calculi ≥ 2cm is PCNL. It is essential that clinicians are aware of the various complications that can arise from PCNL, including arteriovenous fistula, which is typically managed with renal angio--embolization. The development of a renal arteriopelvic fistula (APF) is an extremely rare complication, and accounts of haemorrhage from renal APF and its treatment have not been well-described in the literature. We successfully hypothesized that the ureteroscopic localization, fulguration, and closure with a fibrin sealant at the site of the arterial bleed results in optimal treatment for this clinical presentation. We report this case in detail. Promising Future Implications: The successful and cost-effective endoscopic approach described here for treatment of post-PCNL renal APF and unremitting gross hematuria ought to be considered as an adjunct to renal angiography and embolization when the source of bleeding cannot be accurately identified using traditional imaging modalities.

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Treatment of Complete Staghorn Stones: A Prospective Randomized Comparison of Open Surgery Versus Percutaneous Nephrolithotomy

Abstract: PCNL is a valuable treatment option for complete staghorn stones with a stone-free rate approaching that of open surgery. Moreover, it has the advantages of lower morbidity, shorter operative time, shorter hospital stay and earlier return to work.

Cited by 179 publications

References 20 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

Modified Anatrophic Nephrolithotomy "A Salalah Experience"

A novel endoscopic treatment for renal arteriopelvic fistula post-percutaneous nephrolithotomy (PCNL)

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