Purpose: To compare the safety and efficacy of standard-tract combined with mini-tract to single standard-tract in percutaneous nephrolithotomy (PCNL) for renal staghorn calculi. Methods: The records of 216 patients with staghorn calculi (110 (50.9%) had complete and 106 (49.1%) had partial) who received PCNL were reviewed retrospectively. 58 patients received standard-tract combined with mini-tract PCNL (group A) and 158 patients underwent single standard-tract PCNL (group B). Both groups had comparable demographic data. Operation time, stone-free rate, blood transfusion rate, hospital stay and complications were analyzed. Results: Postoperative Clavien score in the two groups was similar. The rate of blood transfusion and perioperative bleeding requiring superselective embolization were not statistically significant between the groups (p = 0.557, 0.463, respectively). The mean operation time was comparable between groups in the standard-tract combined with mini-tract group. The stone-free rate was significantly higher (89.7 vs. 78.5%, p = 0.044) in group A than in group B. The rate of second PCNL was higher in group B. Conclusion: The standard-tract combined with mini-tract results had higher success rates with no increase in the incidence of complications, and should be the first option for renal staghorn calculi.

Keywords:
Percutaneous nephrolithotomy, Standard-tract, Mini-tract , Standard-tract combined with mini-tract, Staghorn calculi
1.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
2.
Ganpule AP, Desai M: Management of the staghorn calculus: multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol 2008;18:220-223.
3.
Aron M, Yadav R, Goel R, Kolla SB, Gautam G, Hemal AK, Gupta NP: Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int 2005;75:327-332.
4.
Akman T, Sari E, Binbay M, Yuruk E, Tepeler A, Kaba M, Muslumanoglu AY, Tefekli A: Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses. J Endourol 2010;24:955-960.
5.
Manohar T, Ganpule AP, Shrivastav P, Desai M: Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J Endourol 2006;20:547-551.
6.
Netto NR Jr, Ikonomidis J, Ikari O, Claro JA: Comparative study of percutaneous access for staghorn calculi. Urology 2005;65:659-662.
7.
Soucy F, Ko R, Duvdevani M, Nott L, Denstedt JD, Razvi H: Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years. J Endourol 2009;23:1669-1673.
8.
Pevzner M, Stisser BC, Luskin J, Yeamans JC, Cheng-Lucey M, Pahira JJ: Alternative management of complex renal stones. Int Urol Nephrol 2011;43:631-638.
9.
Akman T, Binbay M, Kezer C, Yuruk E, Tekinarslan E, Ozgor F, Sari E, Aslan R, Berberoglu Y, Muslumanoglu AY: Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi: outcomes of a long-term follow-up. J Urol 2012;187:1656-1661.
10.
El-Nahas AR, Eraky I, Shokeir AA, Shoma AM, El-Assmy AM, El-Tabey NA, El-Kappany HA, El-Kenawy MR: Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones. BJU Int 2011;108:750-754.
11.
Maghsoudi R, Etemadian M, Shadpour P, Radfar MH, Ghasemi H, Shati M: Number of tracts or stone size: which influences outcome of percutaneous nephrolithotomy for staghorn renal stones? Urol Int 2012;89:103-106.
12.
Wang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q, Xu N, Lu Z, Hu J, Lu J, Wang X, Hao Y, Wang C: Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 2012;88:307-310.
13.
Desai M, De Lisa A, Turna B, Rioja J, Walfridsson H, D'Addessi A, Wong C, Rosette on Behalf of the Croes PCNL Study Group J: The clinical research office of the Endourological Society Percutaneous Nephrolithotomy Global Study: staghorn versus nonstaghorn stones. J Endourol 2011;25:1263-1268.
14.
Cho HJ, Lee JY, Kim SW, Hwang TK, Hong SH: Percutaneous nephrolithotomy for complex renal calculi: is multi-tract approach OK? Can J Urol 2012;19:6360-6365.
15.
Akman T, Sari E, Binbay M, Yuruk E, Tepeler A, Kaba M, Muslumanoglu AY, Tefekli A: Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses. J Endourol 2010;24:955-960.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.