+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi



Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi



Urologia Internationalis 75(4): 327-332



The treatment of large complete staghorn calculi requires a sandwich combination of percutaneous nephrolithotomy (PCNL) and shockwave lithotripsy (SWL) or sometimes open surgery. Many urologists hesitate to place more than 2-3 tracts during PCNL because of the belief that this may increase complications. We present data to support multi-tract PCNL for large (surface area >3,000 mm(2)) complete staghorn calculi. From July 1998 to October 2003, 121 renal units (103 patients) with large complete staghorn renal calculi were treated with PCNL. All procedures were performed in the prone position after retrograde ureteral catheterization. Fluoroscopy-guided punctures were made by the urologist followed by track dilation to 34 french. When multiple tracts were anticipated all punctures were usually made at the outset and preplaced wires were put into the collecting system or down the ureter. Stones were fragmented and removed using a combination of pneumatic lithotripsy and suction. Postoperative stone clearance was documented on X-ray KUB. 121 renal units of 103 patients (15 women and 88 men, mean age 43 years) were treated. Six patients had associated bladder calculi that were treated simultaneously. The stone surface area was 3,089-6,012 (mean 4,800) mm(2). 10 patients (9.7%) had renal insufficiency with a mean (range) serum creatinine of 3.0 (1.5-5.5) mg/dl. The number of tracts required per patient were 2 tracts in 11, 3 tracts in 68, 4 tracts in 39, and 5 tracts in 3, giving a total of 397 tracts in 121 renal units, over a total of 140 procedures (including second-look procedures in 19 renal units). The points of entry of these tracts were 121 upper calyx (30.4%), 178 middle calyx (44.8%), and 98 lower calyx (24.6%). All 121 units had one upper polar access tract of which 92 (76%) were supracostal. Complications were blood transfusion (n = 18), pseudoaneurysm (n = 2), fever (n = 22), septic shock (n = 1) and hydrothorax (n = 3). PCNL monotherapy achieved an 84% complete clearance rate that improved to 94% with SWL in 8 renal units with small residual fragments. Stone compositions were calcium oxalate (91%), uric acid (2%) and mixed (7%). Aggressive PCNL monotherapy using multiple tracts is safe and effective, and should be the first option for massive renal staghorn calculi.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 012331103

Download citation: RISBibTeXText

PMID: 16327300

DOI: 10.1159/000089168


Related references

Percutaneous nephrolithotomy for complete staghorn calculi in preschool children. Journal of Endourology 19(8): 968-972, 2005

Percutaneous nephrolithotomy for large and staghorn calculi. Journal of Endourology 7(4): 293-295, 1993

Percutaneous nephrolithotomy of staghorn calculi in patients by mini-tract and standard-tract. Zhong Nan Da Xue Xue Bao. Yi Xue Ban 37(8): 840-843, 2012

Standard-tract combined with mini-tract in percutaneous nephrolithotomy for renal staghorn calculi. Urologia Internationalis 92(4): 422-426, 2014

Supine percutaneous nephrolithotomy for bilateral complete staghorn calculi in an L-shaped cross-fused renal ectopic anomaly. Urology 81(1): E3-E4, 2013

Application of Prepuncture on the Double-tract Percutaneous Nephrolithotomy Under Ultrasound Guidance for Renal Staghorn Calculi: First Experience. Urology 114: 56-59, 2018

Combined Single-Tract of Minimally Percutaneous Nephrolithotomy and Flexible Ureteroscopy for Staghorn Calculi in Oblique Supine Lithotomy Position. Surgical Innovation 25(1): 22-27, 2018

A comparison of anatrophic nephrolithotomy and percutaneous nephrolithotomy with and without extracorporeal shock wave lithotripsy for management of patients with staghorn calculi. Journal of Urology 145(4): 710-714, 1991

Simultaneous ureteroscopic lithotripsy and contralateral percutaneous nephrolithotomy for ureteral calculi combined with renal staghorn calculi. International Journal of Urology 22(10): 943-948, 2015

Percutaneous nephrolithotomy eswl vs stent eswl for large stones and staghorn calculi what have we learned?. Journal of Endourology 3(3): 287-294, 1989

Percutaneous Nephrolithotomy/ESWL Stent/ESWL for Large Stones and Staghorn Calculi: What Have We Learned?. Journal of Endourology 3(3): 287-293, 1989

Percutaneous nephrolithotomy in transplanted kidneyforgotten stent with complete staghorn and large bladder stone. Case report. Transplant International 17(12): 877-879, 2004

Percutaneous nephrolithotomy in transplanted kidney--forgotten stent with complete staghorn and large bladder stone. Case report. Transplant International 17(12): 877-879, 2005

Percutaneous nephrolithotomy for complex renal calculi: is multi-tract approach ok?. Canadian Journal of Urology 19(4): 6360-6365, 2012

Percutaneous nephrolithotomy in staghorn renal calculi. Journal of Endourology 8(Suppl. 1): S118, 1994