Main Article Content
Percutaneous nephrolithotomy (PCNL) is a well-established treatment for staghorn stones. Given the im-provement in technology and techniques of flexible ureterorenoscopic lasertripsy (FURS), we retrospectively compared its treatment outcome against PCNL for staghorn stones at our institution.
Materials and Methods
All patients with partial and complete staghorn stones treated by FURS or PCNL between December 2014 and December 2017 were included. Outcome measures included the duration of the procedure, length of stay, retreatment rate, auxiliary rate, complications, and clinical success rates (stone or dust-free status). Results
Out of 22 staghorns, 10 (1 complete, 9 partial) had FURS and 12 (2 complete and 10 partial) had PCNL. Comparatively, the FURS group were older (mean 70.1 vs. 57.1 years, U-test p<0.001) with higher mean ASA scores (mean 2.3 vs. 1.5, U-test, p=0.04), with a similar body-mass index (mean 29.1 vs. 27.3), maximum stone size (29.7 vs. 34.6mm) and Hounsfield unit (836 vs. 891HU).
FURS was quicker to clinical success (102.4min vs. 159.5min, U-test p<0.001) and had shorter hospital stay (1.1d vs. 3.5d, U-test p<0.001). Higher primary procedure success [80% vs. 36%, 95% CI = (-3.0%, 74.5%)], higher overall success [90% vs. 73%, 95% CI = (-22%, 51%)], similar retreatment rate (10%), and higher auxiliary treatment rate (100% vs. 18%) were observed. 1 patient from FURS had a small intrapa-renchymal aspect of staghorn inaccessible to a laser. There were no complications in the FURS group. In the PCNL group, one developed a pseudoaneurysm requiring embolization, and 1 had failed PCNL access (excluded from the statistical calculation).
Our preliminary data suggest that FURS is efficacious and safe for staghorn stones treatment, and comparable to PCNL. In this context, we highlight FURS potential role as first-line management of staghorn stones.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Desai M, Jain P, Ganpule A, et al. Developments in technique and technology: the effect on the results of percutaneous nephrolithotomy for staghorn calculi. BJU Int 2009;104(4):542–8.
3. Shan G and Wang W. ExactCIdiff: Inductive Confidence Intervals for the difference between two proportions. R package version 1.3. 2013. Available at: https:// CRAN.R-project.org/package=ExactCIdiff.
4. Armitage JN, Irving SO, Burgess NA; British Association of Urological Surgeons Section of Endourology. Percutaneous nephrolithotomy in the United Kingdom: results of a prospective data registry. Eur Urol 2012;61(6):1188–93.
5. Al-Kohlany KM, Shokeir AA, Mosbah A, et al. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol 2005;173(2):469–73.
6. El-Nahas AR, Eraky I, Shokeir AA, et al. Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. Arab J Urol 2012;10(3):324–9.
7. Soucy F, Ko R, Duvdevani M, et al. Percutaneous nephrolithotomy for staghorn calculi: a single center’s experience over 15 years. J Endourol 2009;23(10):1669–73.
8. Aron M, Yadav R, Goel R, et al. Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int 2005;75(4):327–32.
9. Wen J, Xu G, Du C, Wang B. Minimally invasive percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery with flexible ureteroscope for partial staghorn calculi: A randomized controlled trial. Int J Surg 2016;28:22–7.
10. Zhao Z, Cui Z, Zeng T, et al. Comparison of 1-stage with 2-stage multiple-tracts mini-percutaneous nephrolithotomy for the treatment of staghorn stones: a matched cohorts analysis. Urology 2016;87:46–51.