Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones.

EL-Nahas, Ahmed R.; Eraky, Ibrahim; Shokeir, Ahmed A; Shoma, Ahmed M.; EL-Assmy, Ahmed M.; EL-Tabey, Nasr A.; EL-Kappany, Hamdy A.; EL-Kenawy, Mahmoud R.

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Short-term results; as stone-free and complication rates; of percutaneous nephrolithotomy for treatment of staghorn stones. Long-term results of PNL; as recurrence rate and differential renal functional changes for treatment of staghorn stones with focus. OBJECTIVE • To study long-term results of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. PATIENTS AND METHODS • The records of patients who underwent PNL for staghorn stones between January 1998 and January 2008 were retrospectively reviewed. • Patients who completed follow-up for one year or more were included. Follow-up with KUB and renal ultrasonography were performed every 3-6 months. • Renal radioisotopic scan was performed for patients who had already undergone this study before doing PNL. RESULTS • The study included 122 patients (69 male and 53 female) with mean age 47.6 ± 14.5 years (5-74). They underwent 126 PNL. • Perioperative complications were encountered in 28 procedures (22%). The mean period of follow-up was 3.5 ± 2.3 years (1-11.3). Among 71 stone-free kidneys, 18 (25%) developed stone recurrence. Of 55 kidneys with residuals at the start of follow-up, 36 (65%) showed growth of these residuals. • Preoperative and postoperative renograms were performed for 71 patients. • At the last follow-up, differential GFR was stable in 53 (74.5%), improved in 12 (17%) and deteriorated in 6 (8.5%). Among patients with deteriorated renal function, 3 had undergone embolization to control severe bleeding, one developed secondary UPJO, and one had recurrent stone obstructing the kidney. CONCLUSION • Long-term functional results of PNL for staghorn stones are satisfactory as 91.5% of kidneys showed stable or improved GFR. Long-term follow-up is mandatory especially for patients with residual stones.

TREATMENT of calculi; ULTRASONIC imaging; URINARY organs; DISEASE complications; KIDNEY stones; HEMORRHAGE

BJU International, 2011, Vol 108, Issue 5, p750

1464-4096

Academic Journal

10.1111/j.1464-410X.2010.09942.x