Efficacy and Safety of Percutaneous Nephrolithotomy in Staghorn Renal Calculi

Abstract: Background:Urolithiasis is the most common ailment presenting to Urology clinics across the globe. Many stones can form Staghorn but struvite stones which is although rare in west is second most common type of staghorn stone in Pakistan. The surgical management of Urolithiasis disease has evolved considerably over the past three decades. Specifically, the introduction and refinement of percutaneous and ureteroscopic access to the upper tracts, along with the nearly simultaneous development of both extracorporeal and intracorporeal lithotripsy has revolutionized the management of staghorn calculi. Being infective stones, the complete stone clearance with good safety profile is the main stay in management of struvite stones. Objective: To determine the efficacy and safety of Percutaneous Nephrolithotomy in management of struvite staghorn calculi. Methodology: It is a descriptive study conducted in department of Urology at Institute of Kidney Diseases Peshawar from March 2010 till December 2019. Total of 230 patients, who underwent PCNL were included in the study by non-probability consecutive sampling technique. We included all patients above 13 years old irrespective of gender with Staghorn calculi. All the preoperative, per-operative and post-operative data was collected on structured proforma and was analyzed on SPSS. Exclusion Criteria: Patients with active infections or growth on urine culture, Previously failed PCNL, Patients not willing for PCNL, Patients with severe skeletal disability not allowing positioning for PCNL .Results: Total of 230 patients were included in the study. 166 (72.2 %) were male while 64 (27.8 %) were female. Mean stone size was 28.8 with range of 18- 42. The mean age of the patients was 37 years Range (18 – 65). Right side was involved 136 patients (59.39%). Conventional PCNL was performed in all cases. Mean operative time from positioning till recovery was 120 min (Range 60- 180 min). Single session complete stone clearance was achieved in 184 (80 %) patient. Pigtail ureteric stents were inserted in all the patients. Ancillary procedure was performed in 46 patients that included 30 patients with ESWL and 16 patients with flexible URS with holmium laser after first session of PCNL. Overall complete stone clearance after 6 weeks postoperatively was achieved in 211 patients (92 %). 30(13%) patients had a bleeding only 08 patients required blood transfusion in immediate post-operative period. 15 patients (6.5%) had Urosepsis which was treated conservatively. No mortality was recorded. Conclusion: PCNL is effective and safe in management of Staghorn renal stones.