title: The optimal minimally invasive percutaneous nephrolithotomy strategy for the treatment of staghorn stones in a solitary kidney.
abstract: The objective of the study was to analyze the treatment outcomes for staghorn stones in patients with solitary kidney using either the single-tract or the multi-tract minimally invasive percutaneous nephrolithotomy (MPCNL). We retrospectively reviewed 105 patients who underwent MPCNL for staghorn calculi in solitary kidney from 2012 to 2014. The patients who underwent the single-tract approach (71 patients) were assigned to Group 1. The 34 patients who underwent the multi-tract approach (34 patients) were assigned to Group 2. We recorded and compared the patient's demographics, intraoperative parameters, and post-operative outcomes. We also analyzed any complications as a result of the particular procedure, as well as any resulting stone-free rates (SFRs). The mean number of access tracts was 2.38 ± 0.70 (range 2-4) for Group 2. The mean operative time was longer for Group 2, p = 0.01. The initial SFR was 52.1% for Group 1 and 47.1% for Group 2 after the one-session procedure, p = 0.63.The final SFR improved to 83.1 and 79.4% for both groups following auxiliary treatment, p = 0.65. The mean hemoglobin drop was higher in Group 2 as compared to Group 1, p < 0.01. There was no significant difference in the change of mean serum creatinine in either group. There were fewer overall complications in Group 1 than in Group 2 (23.9 vs. 44.1%). Almost half of the patients who underwent multi-tract MPCNL required an additional procedure to achieve satisfactory stone clearance. The results showed that single-tract MPCNL might be a better treatment option for staghorn stones in a solitary kidney with the same therapeutic outcome, but with less complications.
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Chenli
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Zelin
authors.initials: Z
authors.lastname: Cui
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. gzgyzgh@vip.tom.com.
authors.forename: Guohua
authors.initials: G
authors.lastname: Zeng
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Shaw P
authors.initials: SP
authors.lastname: Wan
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Jiasheng
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zeng
authors.affiliation: Department of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D000069856:Staghorn Calculi / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complication; Percutaneous nephrolithotomy (PCNL); Solitary kidney; Staghorn calculi; Urolithiasis