Objective: To evaluate the safety and efficacy of single-stage multiple-tract percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones solely guided by ultrasonography (US). Patients and Methods: From May 2007 to July 2012, 55 single-stage multiple-tract PCNL procedures were performed (53 patients, of whom 2 had bilateral stones). Caliceal puncture and dilatation were performed under US guidance in all cases. The procedure was evaluated for access success, length of postoperative hospital stay, complications (modified Clavien system), and stone clearance. Results: The mean (±SD) operating time was 84.87 ± 24.9 min, with a mean (±SD) postoperative hospital stay of 5.2 ± 1.31 days. The patients experienced a mean (±SD) decrease in hemoglobin level of 8.23 ± 2.39 g/l and the stone-free rate after single-stage surgery was 78.18%. Extracorporeal shock wave lithotripsy was indicated in 2 cases as an auxiliary treatment. There were 10 grade 1 (62.5%) and 6 grade 2 (37.5%) complications; however, there were no complications above grade 3. Conclusion: Total US-guided single-stage multiple-tract PCNL for treating staghorn calculi in selected cases is safe, feasible, and may be performed with an acceptable morbidity and with the advantage of preventing radiation hazards and damage to adjacent organs.

Keywords:
Ultrasound, Percutaneous nephrolithotomy, Kidney stone
1.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolfe JS Jr; AUA Nephrolithiasis Guideline Panel: Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
2.
Lam HS, Lingeman JE, Mosbaugh PG, Steele RE, Knapp PM, Scott JW, Newman DM: Evolution of the technique of combination therapy for staghorn calculi: a decreasing role for extracorporeal shock wave lithotripsy. J Urol 1992;148:1058-1062.
3.
Safak M, Olgar T, Bor D, Berkmen G, Gogus C: Radiation doses of patients and urologists during percutaneous nephrolithotomy. J Radiol Prot 2009;29:409-415.
4.
Akman T, Binbay M, Sari E, et al: Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol 2011;25:327-333.
5.
Hosseini MM, Hassanpour A, Farzan R, Yousefi A, Afrasiabi MA: Ultrasonography-guided percutaneous nephrolithotomy. J Endourol 2009;23:603-607.
6.
Karami H, Arbab AH, Rezaei A, Mohammadhoseini M, Rezaei I: Percutaneous nephrolithotomy with ultrasonography-guided renal access in the lateral decubitus flank position. J Endourol 2009;23:33-35.
7.
Tzeng BC, Wang CJ, Huang SW, Chang CH: Doppler ultrasound-guided percutaneous nephrolithotomy: a prospective randomized study. Urology 2011;78:535-539.
8.
Yan S, Xiang F, Yongsheng S: Percutaneous nephrolithotomy guided solely by ultrasonography: a 5-year study of >700 cases. BJU Int 2013;112:965-971.
9.
de la Rosette JJ, Opondo D, Daels FP, et al: Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62:246-255.
10.
Hegarty NJ, Desai MM: Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-760.
11.
Kumari G, Kumar P, Wadhwa P, Aron M, Gupta NP, Dogra PN: Radiation exposure to the patient and operating room personnel during percutaneous nephrolithotomy. Int Urol Nephrol 2006;38:207-210.
12.
Hellawell GO, Mutch SJ, Thevendran G, Wells E, Morgan RJ: Radiation exposure and the urologist: what are the risks? J Urol 2005;174:948-952.
13.
Basiri A, Ziaee AM, Kianian HR, Mehrabi S, Karami H, Moghaddam SM: Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial. J Endourol 2008;22:281-284.
14.
Aron M, Goel R, Kesarwani PK, Seth A, Gupta NP: Upper pole access for complex lower pole renal calculi. BJU Int 2004;94:849-852.
15.
Wong C, Leveillee RJ: Single upper-pole percutaneous access for treatment of > or = 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary? J Endourol 2002;16:477-481.
16.
Clayman RV, Elbers J, Miller RP, Williamson J, McKeel D, Wassynger W: Percutaneous nephrostomy: assessment of renal damage associated with semi-rigid (24F) and balloons (36F) dilation. J Urol 1987;138:203-206.
17.
Traxer O, Smith TG 3rd, Pearle MS, Corwin TS, Saboorian H, Cadeddu JA: Renal parenchymal injury after standard and mini percutaneous nephrostolithotomy. J Urol 2001;165:1693-1695.
18.
Marguet CG, Springhart WP, Tan YH, et al: Simultaneous combined use of flexible ureteroscopy and percutaneous nephro-lithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int 2005;96:1097-1100.
19.
Cheng F, Yu W, Zhang X, Yang S, Xia Y, Ruan Y: Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol 2010;24:1579-1582.
20.
Zhong W, Zeng G, Wu K, Li X, Chen W, Yang H: Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever? J Endourol 2008;22:2147-2151.
21.
Liatsikos EN, Kapoor R, Lee B, Jabbour M, Barbalias G, Smith AD: ‘Angular percutaneous renal access'. Multiple tracts through a single incision for staghorn calculous treatment in a single session. Eur Urol 2005;48:832-837.
22.
Kukreja R, Desai M, Patel S, Bapat S, Desai M: Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 2004;18:715-722.
23.
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.
24.
Chandhoke PS: Cost-effectiveness of different treatment options for staghorn calculi. J Urol 1996;156:1567-1571.
© 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.