Abstract

Objective: We aimed to evaluate the results and comlications of percutaneous nephrolithotomy (PCNL) treatment in patients with staghorn calculi.

Materials and methods: We performed multi-access PCNL in 54 patients with staghorn stones in our department between 2004 to 2007. Of these patients, 2 access tracts were used for 41, 3 access tracts for 8, and 4 access tracts for 5 patients. The mean stone burden was 10.7 cm2 for 2 access group, 11.7 cm2 for 3 access group, and 11.2 cm2 for 4 access group. Preoperative data including stone surface area, stone locations, and patient demograghics were recorded. Access number, transfusion rate, and operative duration were recorded intraoperatively. Stone-free rates and need for opioids were determined postoperatively.

Results: Transfusion rate was 24.3% in 2 access group, 37.5% in 3 access group, and 80% in 4 access group. The mean operative duration was 145, 157, and 189 sec in 2, 3, and 4 access groups, respectively. Stone-free rate was 63.4%, 50%, and 20%; need of opioids was 4.8%, 25%, and 60% in three groups. Two A-V fistulas, one in 3 access group and the other in 4 access group, were treated by chemoembolisation.

Conclusion: Stone burden is not the most important factor for stone-free rates in complex and branched renal calculi. Different caliceal locations of stones is more predictive for stone-free rates for staghorn stones. Increased access number is associated with more blood transfusion, long operative duration, more complications, and more opioid needs.