![]() Some studies suggested that open or laparoscopic surgery is an efficient method for the management of large and complex renal stones associated with a high single-session stone-free rate. ĭifferent treatment modalities include open surgery, laparoscopy, percutaneous nephrolithotomy (PCNL), multi-staged ureterorenoscopy (URS) in selected cases, and endoscopic combined intrarenal surgery (ECIRS). Particularly when the stone burden reaches > 2000 mm 2, surgical treatment remains technically difficult regardless of the treatment modality used. Staghorn stones, by definition, are branched into two or more calyces. The estimated five-year recurrence rate is up to 50%. Due to their high recurrence rates, particularly in infectious stones, complete removal of stone material is mandatory. The treatment of staghorn stones is challenging. When auxiliary combination treatments are not available, multitract standard PCNL remains an option. Multitract PCNL is safe and efficient, with a good stone-free rate and an acceptable complication rate. There were no grade IV and V complications. 20% of patients developed grade I, 14% grade II, and 3% grade III b complications. The number of tracts varied between 2 and 4 in a single renal unit. In a total of 65 patients, 154 percutaneous access tracts were used in 66 renal units. Complications were graded according to the modified Clavien-Dindo classification. Hb-drop and creatinine changes were assessed pre- and post-OP. Data included demographics, stone parameters, intraoperative parameters, complications and clinical outcomes. We analyzed data on sixty-five patients with staghorn calculus who underwent multitract PCNL for a staghorn calculus. The aim of this study was to assess the safety and efficacy of multitract PCNL in such an environment. However, in a country with limited access to technology and a restraint on resources, multitract PCNL still is the preferred option. PCNL has been combined with SWL, flexible URS (ECIRS), and mini-PCNL to access residual fragments without the need of additional tracts. Often, multiple access tracts are needed to render the patient stone-free. Percutaneous nephrolithotomy is the first-line treatment for staghorn stones. Production and hosting by Elsevier B.V.Staghorn stones are difficult to manage with a risk of significant renal impairment and urosepsis. © 2020 Editorial Office of Asian Journal of Urology. Imaging Kidney access Preoperative planning Staghorn stone. This entity should be managed aggressively with planning ahead for surgery using the different tools available as the cornerstone for a successful outcome. Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis. Conservative management of staghorn calculi is an undesired option, but can be an alternative for a carefully selected group of high-risk patients. There is a growing trend of endoscopic combined intrarenal surgery (ECIRS) in concordance with PCNL to treat larger stones. Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones, with significantly less complications rate Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density (STONE) nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases. Staghorn morphometry-based prediction algorithms may predict the number of tract(s) and stage(s) for PCNL monotherapy. New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported, but have not shown utilization in staghorn cases. Wideband doppler ultrasound and real-time virtual sonography can assist. Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus. Non-contrast computerized tomography (NCCT) is indeed the standard imaging tool for percutaneous nephrolithotomy (PCNL) additional tools such as three-dimensional computed tomography (CT) reconstruction of the staghorn calculus may help plan access in complex cases. We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones. In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition. Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones. Staghorn calculi present a particular and challenging entity of stone morphology. ![]()
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