Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone: Technique and outcomes

Abstract

Objective: To describe the technique and outcomes of antegrade ureteroscopic assistance during the initial nephrostomy access for the management of renal staghorn stone. Materials and methods: From 2000 to 2009, a total of 153 patients with complete staghorn stones were treated with percutaneous nephrolithotomy (PCNL) at our hospital. Antegrade ureteroscopic assistance was applied, starting in the 50th patient, during the initial nephrostomy access so as to prevent the creation of a false tract and to create more intracalyceal space for subsequent tract dilation. We report the characteristics of the patients, stones, treatment outcomes, and complications in the groups with and without antegrade ureteroscopic assistance. Results: Intergroup differences in the groups with (n = 104) and without (n = 49) antegrade ureteroscopic assistance with regard to the patients' characteristics and stone surface areas were not significant (24.0 ± 18.1 cm2 versus 21.8 ± 11.8 cm2). Patients who underwent PCNL with antegrade ureteroscopic assistance required a significantly shorter operation time and hospital stay than those who underwent PCNL without antegrade ureteroscopic assistance (143 ± 78 minutes versus 105 ± 35 minutes, p < 0.0001; 5.4 ± 2.9 days versus 4.3 ± 2.2 days, p = 0.009, unpaired t test). Furthermore, intergroup differences with regard to the stone-free rate, transfusion rate, and incidence of postoperative urosepsis were not statistically significant (p = 0.67, p = 0.18, and p = 0.75, respectively). Conclusion: Such an ancillary procedure might be suitable for the management of complete staghorn stones or other complex renal stones in patients in whom adequate intracalyceal space was not available for the creation of nephrostomy access.

Keywords

• antegrade ureteroscopic assistance
• percutaneous nephrolithotomy (PCNL)
• renal staghorn stone