title: The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome.
abstract: The objective of this study was to analyze the outcome of percutaneous nephrolithotomy (PCNL), laparoscopic and open anatrophic nephrolithotomy (AN) for management of patients with large staghorn renal stones. We analyzed the peri-operative parameters, overall treatment costs and changes in the function of the affected kidney on technetium-99 dimercaptosuccinic acid renal scintigraphy, done before the operation and before the final follow-up visit, in 45 adults who underwent PCNL (n = 16) versus laparoscopic (n = 15) versus open (n = 14) AN for large staghorn renal stones. All three groups had statistically similar preoperative characteristics, including the function of the operated kidney on renal scan. On the discharge day, the PCNL group had the lowest stone-free rate (43.75 %) compared to the laparoscopic (80 %) and open AN groups (92.85 %) (P = 0.009). After a mean follow-up period of 12.1 months, the decrease in the function of the operated kidney was greatest in the open AN group (-8.66 ± 4.97) compared to the laparoscopic AN (-6.04 ± 6.52) and PCNL group (-2.12 ± 2.77) (P = 0.003). The need for ancillary procedures to manage residual stones was greatest in the PCNL group and lowest in the open AN group. A similar trend was seen in overall treatment costs (P < 0.001). For management of large staghorn renal stones, the more invasive the procedure, the higher the one-session stone-free rate and the lower the need for ancillary procedures; however, greater renal functional loss can be anticipated. The need for ancillary procedures is a major determining factor in the overall cost of treatment, which was highest in the PCNL group.
authors.affiliation: Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Zand Street, P.O. Box 71344, Shiraz, Iran. aminsharifi_ar@yahoo.com.|Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. aminsharifi_ar@yahoo.com.
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.affiliation: Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Zand Street, P.O. Box 71344, Shiraz, Iran.
authors.forename: Dariush
authors.initials: D
authors.lastname: Irani
authors.affiliation: Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Zand Street, P.O. Box 71344, Shiraz, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Masoumi
authors.affiliation: Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Zand Street, P.O. Box 71344, Shiraz, Iran.
authors.forename: Bahman
authors.initials: B
authors.lastname: Goshtasbi
authors.affiliation: Toronto General Hospital, Toronto, Canada.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Aminsharifi
authors.affiliation: Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Zand Street, P.O. Box 71344, Shiraz, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Mohamadian
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D000069856:Staghorn Calculi / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anatrophic nephrolithotomy; Laparoscopy; Nephrolithotomy; Percutaneous nephrolithotomy; Renal stone; Staghorn renal calculi