Aggressive approach to staghorn calculi - Safety and efficacy of multiple tracts percutaneous nephrolithotomy

OBJECTIVES To evaluate the safety and efficacy of an aggressive approach to staghorn calculi using multiple-tract percutaneous nephrolithotomy. METHODS We retrospectively analyzed the data from 149 patients with staghorn calculi, who underwent percutaneous nephrolithotomy using multiple (two or more) access tracts, at our institute from 1999 to 2006. The data were analyzed with regard to stone burden, stone clearance, perioperative morbidity, complications, and the number of ancillary procedures. RESULTS A total of 164 renal units in 149 patients (118 men and 31 women, mean age 39.8 years, range 12 to 65 years) were treated. Of the 164 renal units, 43 (26.2%) had a complete staghorn, 85 (51.8%) had a partial staghorn and 36 (21.9%) had a borderline stone bulk. A total of 420 tracts were established in the 164 renal units. The maximal number of tracts used in a single renal unit was six (range two to six), most required three tracts. Supracostal access was established in 98 renal units (59.7%). The complications included blood transfusion in 46 patients, pseudoaneurysm in 4, sepsis in 8, hydrothorax in 7, hemothorax in 1, and perinephric collection in 1 patient. A complete stone clearance rate of 70.7% was achieved after a single session of percutaneous nephrolithotomy that increased to 89% after a second-look procedure (n = 30) and extracorporeal shock wave lithotripsy (n = 16). CONCLUSIONS The results of our study have shown that an aggressive approach to staghorn calculi using multiple-tract percutaneous nephrolithotomy is safe and effective in achieving a greater stone clearance rate with acceptable morbidity. A supracostal approach can be used more often without increasing the risk of significant complications.