Percutaneous nephrolithotomy in treatment of staghorn kidney stones

Introduction. Percutaneous nephrolithotomy is considered as the gold standard in the treatment of patients with full staghorn kidney stones. Its effectiveness varies from 55% to 98%, which depends on many factors, and in particular, on the accessibility to the stones. The aim of the study was to analyze out own experience of performing PCNL in patients with staghorn kidney stones (stages K3-K4). Materials and methods. We performed 2456 percutaneous nephrolithotomies over the period of 2010-2015. 938 patients were found to have staghorn kidney stones (stages K3-K4). 48.2% of operations were performed according to the multi-PCNL method. Results. The effectiveness of mono- and multi-PCNL was 53.6% and 83.8%, respectively. The median number of patient days for mono- and multi-PCNL was 6.6 (5.4;8.7) and 10.2 (8.6;12.3), respectively. The percentage of complications developed was 20.3% for mono-PCNL and 25.5% for multi-PCNL. Bleeding was observed in 46 (9.5%) and 54 (11.9%) patients in mono- and multi-PCNL groups, respectively. During the postoperative stage 25 (5.1%) and 26 (5.8%) patients needed blood transfusion after mono- and multi-PCNL. Discussion. There is a difference of opinions concerning the choice and method of kidney drainage in the final stages of PCNL. In particular, how many nehprostomies are required and when? Our point of view depends on the degree and severity of bleeding in the end of operation, size and chemical composition of a stone, presence and degree of bacteriuria, deficiency of kidney secretory function, duration of surgical intervention, surgeon accuracy and anatomical peculiarities of the pyelocaliceal system. The issue of bleeding frequency, which depends on the number of access procedures, is being widely discussed. In our study the percentage of hemorrhagic complications was 9.5% for mono-PCNL and 11.9% for multi-PCNL (p>0.05). No statistically significant difference between the groups of patients and between such criteria as the need for kidney revision emergency nephrectomy and renal vessels embolization (p>0.05). Results. Multi-PCNL is a highly effective method for treating patients with complex forms of nephrolithiasis.