title: Management of staghorn calculus: analysis of combination therapy and open surgery.
abstract: OBJECTIVE
  To assess the role of primary open surgery versus the recommended combination approach (percutaneous and lithotripsy) to treat staghorn calculi in a developing country.
  
  
  METHODS
  Available records (n = 91) of patients with staghorn managed during the last 4 years were retrieved. Patients were placed in two groups, open surgery and combination group, according to the primary procedure chosen by the patient. Demographic data in two groups was comparable in most of the respects except that renal failure patients were more in the combination group. Stone clearance, major residue, auxiliary procedures, morbidity, hospital stay and the cost were studied in the two groups for comparison.
  
  
  RESULTS
  Complete clearance could be obtained in 66 and 59% with open and combination method respectively. Major residue (> 16 mm2) was present in 21% of open and 38% of the combination group. In patients with primary stone burden < 900 mm2, the total clearance rates were 66 and 60% in open and combination group, respectively. Total clearance was not affected by caliceal dilatation, total stone burden, pelvic and caliceal bulk separately or their ratio, as arrived by logistic regression analysis. The incidence of haematuria in the combination group was marginally higher, probably due to more renal failure patients in this group. Hospital stay in the two groups was comparable (13.0 days in combination vs. 12.1 days for open). The cost of treatment with combination group was significantly higher.
  
  
  CONCLUSIONS
  Open surgery for staghorn is still an economically viable option for difficult stone disease, specially in a developing country, with comparable efficacy, favourable morbidity and hospital stay.
authors.affiliation: Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. maheshg@princephilip.demon.co.uk
authors.forename: M C
authors.initials: MC
authors.lastname: Goel
authors.forename: R
authors.initials: R
authors.lastname: Ahlawat
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003906:Developing Countries; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D007669:Kidney Calculi / Q000737:chemistry / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008096:Lithotripsy; D016015:Logistic Models; D017616:Magnesium Compounds; D008297:Male; D008875:Middle Aged; D010710:Phosphates; D000069877:Struvite
chemical_list: D017616:Magnesium Compounds; D010710:Phosphates; D000069877:Struvite