BACKGROUND

Staghorn calculi are complicated renal stones that are frequently linked to hydronephrosis, a parameter that can have a major impact on the results of surgery. Percutaneous nephrolithotomy (PCNL) is widely recognized as the gold standard for treating large kidney stones and staghorn calculi. Data on the effect of preoperative hydronephrosis on PCNL perioperative outcomes is still limited.

OBJECTIVE

This study aimed to investigate the association between preoperative hydronephrosis and perioperative outcomes among patients undergoing PCNL in a tertiary government hospital in Manila.

METHODS

A single-center prospective cohort study was conducted, involving 90 patients diagnosed with staghorn calculi and scheduled for elective PCNL. Patients were categorized into two groups based on the presence or absence of moderate-to-severe hydronephrosis as determined by preoperative imaging. Perioperative outcomes, including total operative time, access time, lithotripsy time, and perioperative complications such as bleeding and sepsis, were evaluated. Data were analyzed using linear and logistic regression models to assess associations between hydronephrosis and perioperative outcomes.

RESULTS

The presence of hydronephrosis was associated with a statistically significant reduction in access time (p = 0.036), likely due to the dilation of renal structures facilitating easier entry. However, hydronephrosis was linked to a borderline significant reduction in lithotripsy rate (p = 0.051), indicating potential challenges in stone fragmentation. No significant association was found between hydronephrosis and total operative time or perioperative complications, such as bleeding and sepsis.

CONCLUSION

While hydronephrosis may make kidney access and other technical aspects of PCNL easier, it may also make stone fragmentation more difficult. Larger stone size and stone location were significant predictors of longer operative times and slower lithotripsy rates, underscoring their critical role in surgical outcomes.

Human ; Staghorn Calculi ; Nephrolithotomy, Percutaneous ; Kidney Calculi ; Hydronephrosis

INTRODUCTION AND OBJECTIVE

The endoscopic management of staghorn calculi is very challenging owing to its complex anatomical configuration. The authors analyzed the clinical efficacy and safety of a single upper pole access PCNL (SUPA-PCNL) for Guy Stone Score (GSS) 3-4 staghorn calculi.

METHODS

Prospective data collection was done on 56 consecutive patients who with GSS 3-4 staghorn calculi. All cases were treated with a standardized technique of a single upper pole access PCNL in the prone position. The patient demographics, stone characteristics, perioperative and postoperative outcomes were analyzed.

RESULTS

The cohort exhibited diversity in age (51.7+12), gender (male to female ratio of 5.5:4.5) comorbidities, and stone burden (4.82+1.96 cm). SUPA-PCNL demonstrated a high median stonefree rate (99.5%, IQR 90-100) with minimal complications, low blood loss with a of 200cc (IQR 100-300), and median hospital stay of 3.5 days (IQR 3-5). Stone characteristics did not significantly influence outcomes. A subset required secondary treatments (12%, n=7), but overall morbidity was low (16%, n=9): (7% n=4) of which required blood transfusion, and (9% n=5) due to sepsis. The following factors were associated with increased odds of perioperative morbidity: preoperative creatinine >3 mg/dl (OR 4.19 95% Cl 0.59 – 29.71 p=0.152) and a history of endoscopic surgery (OR 7.33 95% Cl 1.20-44.96 p=0.031).

CONCLUSION

SUPA-PCNL is effective and safe for the treatment of staghorn calculi. In select patients, this approach obviates the need for a multi-tract access or an endoscopically-combined intrarenal surgery (ECIRS).

Human ; Nephrolithotomy, Percutaneous ; Morbidity ; Staghorn Calculi

Squamous cell carcinoma (SCC) of the kidney is a rare malignancy and has a poor prognosis because it is usually detected and presents at an advanced stage of the disease. Due to lack of studies regarding its clinical course and its radiologic features, it is usually not detected and presents as an incidental finding in histopathologic results. This type of malignancy more often is related to Renal stones secondary to chronic infection, inflammation, and irritation. A 52-year-old Filipino woman was referred to this institution due to flank pain and constant weight loss. The authors administered antibiotics then performed simple nephrectomy on her. A pathologic examination revealed Squamous Cell Carcinoma with Sarcomatoid differentiation. Four months after the operation, patient was readmitted due to lowback pain and generalized weakness which led to a suspicion of a possibility of Bone Metastasis. Patient was offered further workups such as whole abdominal CT scan with contrast and other palliative treatments however she refused and opted to be discharged despite medical advice. Patient then died 2 weeks after being home against medical advice.
Carcinoma, Squamous Cell ; Staghorn Calculi

Adult ; Aged ; Endoscopy ; methods ; Female ; Humans ; Kidney Calculi ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Staghorn Calculi ; surgery ; Young Adult

From July 1987 to May 1990, a total of 13 simultaneous bilateral percutaneous nephrolithotripsies (PCNL) were performed in two medical institutions for bilateral proximal ureteral stones, bilateral pelvolithiasis and nephrolithiasis, and bilateral staghorn calculi. No major complications occurred. It appears that simultaneous bilateral PCNL has several advantages including reasonable operative time, safety of the procedure and cost effectiveness. Greater applications of this procedures is encouraged. (Author)

Human ; Male ; Female ; Middle Aged ; Adult ; Urinary Calculi ; Nephrolithiasis ; Staghorn Calculi