title: Percutaneous management of staghorn calculi in horseshoe kidneys: a multi-institutional experience.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PNL) is a first-line management technique for staghorn stones and stones located in a horseshoe kidney (HK). We present our multi-institutional experience on the management of staghorn calculi within HKs.
  
  
  METHODS
  The study included 15 patients with 17 staghorn calculi in HKs who were treated by PNL in six academic institutions. All PNL procedures were performed in a standard one-session technique with fluoroscopic guidance. The following information was assessed: Number of access dilations, renal access location, blood loss, blood transfusion, stone-free rate, length of hospitalization. Intraoperative and postoperative complications as well as secondary procedures (second-look PNL, ureteroscopy, and shockwave lithotripsy) were reviewed.
  
  
  RESULTS
  Mean patient age was 50 years (range 24-72 y) years old. Subcostal (n = 16) or intercostal (n = 1) puncture was performed. The average anesthesia time was 126 minutes (93-200 min). The average blood loss was 450 mL, and transfusions were deemed necessary in 20% of the cases. Single skin incisions were made for the management of 11 renal units, and multiple incisions were made in 6. The average number of tract dilations per renal unit was 2.11 (range 1-4). The overall stone-free rate was 82%. The average length of hospital stay was 4.4 days (range 3-7). The average duration of nephrostomy tube drainage was 80 hours with a range of 72 to 96 hours. Major and minor complication rate was 20% and 46.6%, respectively.
  
  
  CONCLUSIONS
  The performance of PNL is a safe and effective method to manage staghorn calculi in HKs.
authors.affiliation: Department of Urology, University of Patras, School of Medicine, Patras, Greece. liatsikos@yahoo.com
authors.forename: Evangelos N
authors.initials: EN
authors.lastname: Liatsikos
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: Micheal
authors.initials: M
authors.lastname: Ost
authors.forename: Frank
authors.initials: F
authors.lastname: Keeley
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
authors.forename: Norberto
authors.initials: N
authors.lastname: Bernardo
authors.forename: Petros
authors.initials: P
authors.lastname: Perimenis
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000473:pathology*; D007669:Kidney Calculi / Q000601:surgery*; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011677:Punctures; D055815:Young Adult