title: Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses.
abstract: OBJECTIVE
  To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi.
  
  
  METHODS
  The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed.
  
  
  RESULTS
  The mean number of percutaneous accesses was 2.42 +/- 0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P = 0.002, P < 0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P = 0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P < 0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03 mg/dL and 1.08 mg/dL in group 1, and 0.9 mg/dL and 1.03 mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P = 0.16).
  
  
  CONCLUSIONS
  The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi.
authors.affiliation: Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Akman
authors.forename: Erhan
authors.initials: E
authors.lastname: Sari
authors.forename: Murat
authors.initials: M
authors.lastname: Binbay
authors.forename: Emrah
authors.initials: E
authors.lastname: Yuruk
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kaba
authors.forename: Ahmet Yaser
authors.initials: AY
authors.lastname: Muslumanoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tefekli
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007669:Kidney Calculi / Q000097:blood / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D003404:Creatinine