title: Endoscopic guided additional access for staghorn calculi.
abstract: OBJECTIVE
  Flexible nephroscopy is an important technique in the management of staghorn renal calculi to reach peripheral calices. In this study, we present our experience with flexible nephroscopy and fluoroscopy-guided additional access creation for staghorn renal calculi.
  
  
  METHODS
  We conducted a retrospective analysis of patients with staghorn renal calculi who were treated with multiple percutaneous renal tracts created with the guidance of flexible nephroscopy and fluoroscopy. Additional tracts were performed with combined flexible nephroscopy and fluoroscopy guidance. Flexible nephroscopy was used to help target the calix and ensure the safety of access.
  
  
  RESULTS
  Additional percutaneous renal access was achieved using combined flexible nephroscopy and fluoroscopy guidance in 26 patients with complete staghorn (n=21) and partial staghorn (n=5) kidney stones. The cumulative stone size was 59.3 mm. The mean procedure times, fluoroscopy times, and hospitalization times were 91.5 minutes, 3.4 minutes, and 2.7 days, respectively. The postoperative hematocrit drop was 4.96±3.8. Upper and lower calices were the most common primary access tracts in 11 and 15 patients, respectively. Stone-free status was achieved in 22 (84.6%) patients with a mean 2.1±0.3 tract number. Postoperative complications were observed in six (23.1%) patients.
  
  
  CONCLUSIONS
  In the requirement of additional access for staghorn renal calculi, use of flexible nephroscopy with fluoroscopy increases the safety of the procedure by confirmation of precise renal access.
authors.affiliation: 1 Department of Urology, Ataturk University , Erzurum, Turkey .
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ziypak
authors.forename: Senol
authors.initials: S
authors.lastname: Adanur
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.forename: Mehmet Remzi
authors.initials: MR
authors.lastname: Erdem
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Akcay
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armagan
authors.forename: Isa
authors.initials: I
authors.lastname: Ozbey
authors.forename: Ozkan
authors.initials: O
authors.lastname: Polat
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000601:surgery*; D007670:Kidney Calices / Q000601:surgery*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D055815:Young Adult