A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy

• Published in: World journal of urology 2018-09, Vol.36 (9), p.1461-1467
• Main Authors: Blum, Kyle A., Parkhomenko, Egor, Thai, Julie, Tran, Timothy, Gupta, Mantu
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Calcification (ectopic); Female; Humans; Kidney Calices; Kidney Pelvis; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Nephrolithotomy, Percutaneous - adverse effects; Nephrolithotomy, Percutaneous - methods; Nephrology; Oncology; Original Article; Patients; Postoperative Complications; Prospective Studies; Staghorn Calculi - surgery; Surgery; Treatment Outcome; Urology; Young Adult
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-018-2284-9

Purpose Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment for staghorn stones. Two approaches are commonly employed to gain access into the collecting system which consists of either an upper pole (UP) approach or lower pole (LP) approach. However, opinions vary on which approach offers the best access and outcome. In this study, we aim to challenge the traditional paradigm that staghorn stones are most effectively treated through a prone UP approach. We herein report our institutional experience using a prone LP access in PCNL for patients with complete staghorn stones. Methods Data were prospectively collected over 3 years on 473 PCNL procedures, of which 76 patients had complete staghorn calculi (five or more calyces). Operative and peri-operative outcomes were analyzed to compare a modified LP approach with the more widely accepted UP approach. Results A total of 59/76 (77.6%) patients had LP access. There was no difference in the ability of completing the surgery utilizing a single tract as opposed to multiple tracts (74.6% of LP patients vs. 76.5% of UP patients). Stone-free rates for LP and UP access were similar (74.5 versus 70.5%, respectively; p  = 0.760. Complication rates were lower for LP access vs. UP access (3.4 vs. 23.5%, p  = 0.02) with two pulmonary complications in the UP group. Overall median operative time was not significantly different between LP and UP access (112.0 vs. 126.0 min, p  = 0.486). Conclusions Prone LP access demonstrated similar efficacy with decreased morbidity in patients with complete staghorn calculi compared to prone UP access.