The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: Staghorn Versus Nonstaghorn Stones

Abstract

Purpose: The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. Patients and Methods: Data over a 1-year period from consecutively treated patients from 96 centers worldwide were collated. The following variables in patients with staghorn or nonstaghorn stones were compared: National prevalence, patient characteristics, access method, puncture frequency and outcomes, including bleeding rates, operative time, and duration of hospital stay. Results: Data from 5335 eligible patients were collated; 1466 (27.5%) with staghorn and 3869 (72.5%) with nonstaghorn stones. Staghorn stone presentation varied between centers from 67% in Thailand to 13% in Argentina. The frequencies of previous procedures were similar between groups, but shockwave lithotripsy was less frequent in patients with staghorn stones compared with nonstaghorn (16.8% vs 22.6%) and positive preoperative urine cultures were more frequent in patients with staghorn than nonstaghorn stones (23.4% vs 13.1%). Patients with staghorn stones underwent multiple punctures more frequently than those with nonstaghorn stones (16.9% vs 5.0%). Postoperative fever, bleeding, and the need for blood transfusion were more frequent, the median operative time and duration of hospital stay were longer, while the proportion of patients remaining stone free was lower (56.9% vs 82.5%) in patients with staghorn than nonstaghorn stones. Conclusions: The proportion of patients with staghorn stones varies widely between centers. Stone-free rates were lower, complications more frequent, and operative time and hospital stay were longer in patients with staghorn stones. Editorial CommentThe findings of this study are not unexpected; staghorn calculi present a unique challenge to the endourologist; with anticipated higher rates of complications and lower rates of success. However, the study demonstrates clearly that though the rates of complications were higher and hospital stay and OR times longer, they were not prohibitively so; PCNL remains a high standard of care for staghorn calculi. The information provided is useful for counseling patients on the contemporary risks of PCNL and the anticipated success and recuperation. Though the authors report that staghorn calculi are more common in women and have a higher rate of positive urine cultures, they did not report the stone analyses on these patients. It would be useful to evaluate whether the risk of infectious complications is higher in patients with struvite calculi. The relatively low utilization of multiple accesses for staghorn calculi alludes to a high utilization of flexible endoscopes and adjunctive procedures such as flexible ureteroscopy and SWL. The authors do not report the percentage of patients who indeed underwent these procedures. Advocates of the multiple access approach would likely conclude that the low stone free rate of 57%...

Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high‐power holmium laser versus ultrasonic lithotripsy

“…The SFR of 57% after US-L and 60% after HP-HLL in the present study were comparable to the global PCNL study for staghorn stones [12]. The SFR of 66% at 3 months after HP-HLL in the present study was lower than that reported by Sun et al [6] (88% at 3 months).…”

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

“…This is higher than the stone-free rate reported by Al - Kohlany et al (49%) 8 because they only considered and treated complete staghorn calculi, whereas in this study we included both patients with partial staghorn calculi and complete staghorn calculi and we made no distinction between partial and complete staghorn calculi. Stone-free rate in our study was not very different from the research conducted by El-Nahas et al 14 (56.6%) and Desai et al 9 (56.9%). They included subject criteria similar to our study, namely the complete and partial staghorn calculi 14 .…”

“…Nevertheless, the management of staghorn calculi with PCNL remains challenging. Stone-free rates were lower, complications more frequent, and operative time and hospital stay were longer in patients with staghorn stones compared to nonstaghorn stones 9 .…”

Outcome of PCNL- Success &Complications

“…[2,[14][15][16][17]. In our study overall stone free status(SFS) was 88.72%, of that GSS 1-100%, GSS 2-93.95%, GSS 3-79.5% and GSS 4-39.13%.…”