title: Combination of debulking single-tract percutaneous nephrolithotomy followed by retrograde intrarenal surgery for staghorn stones in solitary kidneys.
abstract: OBJECTIVE
  The aim of this study was to report a therapeutic approach comprising a combination of debulking single-tract percutaneous nephrolithotomy (PCNL) and subsequent retrograde intrarenal surgery (RIRS) for treatment of staghorn stones in patients with solitary kidney.
  
  
  METHODS
  A retrospective review was undertaken of 56 patients with staghorn stones in a solitary kidney who underwent the above-mentioned combination therapy. PCNL was first performed for stone debulking and RIRS was then used to remove residual stones after an interval of 2-4 days. Data were collected on operative parameters, stone-free rate (SFR), complications and renal functions.
  
  
  RESULTS
  The staghorn stones had a mean stone burden of 2548 ± 1028 mm(2) (range 1438-3956 mm(2)). The SFR after 3 months was 89.3%. The overall blood transfusion rate was 7.1%. Complications were observed in nine patients (16.1%), including selective renal artery embolization, fever, gross haematuria and steinstrasse in one, two, three and three cases, respectively. At a mean follow-up of 31 months, available in 38 patients, kidney function was stable in 71%, improved in 26.3% and worsened in 2.7%, according to serum creatinine levels that remained within ±20%, or that increased or decreased outside this range. No patient required haemodialysis.
  
  
  CONCLUSIONS
  Combining single-tract PCNL with subsequent RIRS was an effective strategic option for treating staghorn stones in solitary kidneys. The method gave an excellent SFR, satisfactory preservation of renal function, reduced bleeding risk and potentially less morbidity than that associated with multiple-tract PCNL.
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology , Guangzhou , PR China.
authors.forename: Guohua
authors.initials: G
authors.lastname: Zeng
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Zhao
authors.forename: Wenqi
authors.initials: W
authors.lastname: Wu
authors.forename: Wen
authors.initials: W
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D014564:Urogenital Abnormalities / Q000150:complications; D055815:Young Adult
keywords: percutaneous nephrolithotomy; retrograde intrarenal surgery; solitary kidney; staghorn stone