Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

Keywords:
Percutaneous nephrolithotomy, Solitary kidney, Staghorn calculi, Retrograde intrarenal surgery
1.
Preminger GM, Assimos DG, Lingeman JE, et al; AUA Nephrolithiasis Guideline Panel: Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
2.
Manohar T, Ganpule AP, Shrivastav P, et al: Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J Endourol 2006;20:547-551.
3.
El-Nahas AR, Shokeir AA, El-Assmy AM, et al: Post percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007;177:576-579.
4.
Jackman SV, Docimo SG, Cadeddu JA, et al: The ‘mini-perc' technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol 1998;16:371-374.
5.
Lahme S, Bichler KH, Strohmaier WL, et al: Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 2001;40:619-624.
6.
Zhong W, Zeng G, Wu W, et al: Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res 2011;39:117-122.
7.
Marguet CG, Springhart WP, Tan YH, et al: Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int 2005;96:1097-1100.
8.
Xu G, Li X, He Y, et al: Staged single-tract minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney. Urol Res 2012;40:745-749.
9.
Ibarluzea G, Scoffone CM, Cracco CM, et al: Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007;100:233-236.
10.
Resorlu B, Kara C, Oguz U, et al: Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. Urol Res 2011;39:171-176.
11.
Undre S, Olsen S, Mustafa N, et al: ‘Pass the ball!' Simultaneous flexible nephroscopy and retrograde intrarenal surgery for large residual upper-pole staghorn stone. J Endourol 2004;18:844-847.
12.
Giusti G, Piccinelli A, Taverna G, et al: Miniperc? No, thank you! Eur Urol 2007;51:810-815.
13.
Aron M, Yadav R, Goel R, et al: Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int 2005;75:327-332.
14.
Hamamoto S, Yasui T, Okada A, et al: Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantages of percutaneous nephrolithotomy monotherapy. J Endourol 2014;28:28-33.
15.
Bucuras V, Gopalakrishnam G, Wolf JS Jr, et al: The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: nephrolithotomy in 189 patients with solitary kidneys. J Endourol 2012;26:336-341.
© 2014 S. Karger AG, Basel
2014
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