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| Multitract percutaneous nephrolithotomy in staghorn calculus |
Arvind P. Ganpulea,*( ),M. Naveen Kumar Reddya,S.B. Sudharsana,Shaishav B. Shahb,Ravindra B. Sabnisa,Mahesh R. Desaia
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a Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
b NHL Municipal Medical College, Ahmedabad, India |
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Abstract Staghorn calculi are branched stones which occupy a majority portion of the pelvicaliceal system. An untreated staghorn calculus over time can damage the kidney and deteriorate its function and/or cause life threatening sepsis. Total stone clearance is an important goal in order to eradicate any infective focus, relieve obstruction, prevent recurrence and preserve the kidney function. Percutaneous nephrolithotomy (PCNL) is currently the accepted first-line treatment option for staghorn calculi. The options available are single-tract PCNL with an auxiliary procedure like shockwave lithotripsy, single-tract PCNL with flexible nephroscopy, or multitract PCNL. Each has its own pros and cons. But the ultimate goal of treatment for any patient with staghorn calculi should be safety, cost-effectiveness, and to achieve total stone clearance. With this article, we review the management of staghorn calculi with multiple percutaneous (“multitract”) access, its advantages and disadvantages and its current position by studying the various published materials across the globe.
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Received: 04 March 2019
Available online: 08 October 2019
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Corresponding Authors:
Arvind P. Ganpule
E-mail: doctorarvind1@gmail.com
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| Studies | No. of renal units | No. of tracts (most commonly) | Stone free rate (%) | Complications (major) (%) | Blood transfusion (%) | Hospital stay, mean (range), day | | Singla et al. [23] | 149 | 2-6 (3) | 88.9 | 14 | 46 | 6.8 (3-28) | | Aron et al. [14] | 121 | 2-3 (2) | 84 | 4.1 | 14.8 | Not mentioned | | Zeng et al. [25] | 100 | 2-3 | 93 | 4 | 3 | 9.4 (6-13) | | Liatsikos et al. [11] | 100 | 2-6 (2) | 87 | 10 | 45 | 4.6 (3-14) | | Wong and Leveillee [13] | 35 | 2-3 | 95 | 2.8 | 2.2 | 2 (1-10) | | Hegarty and Desai [19] | 20 | 2-6 (3) | 95 | 10 | 20 | 4.25±1.74 | | Marguet et al. [16] | 7 | 2-3 | 71.4 | 0 | 0 | Not mentioned | | Desai et al. [5] | 500 | 2-3 | 84.1 | 5 | 12.4 | 11.1 |
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Studies of multiple tract percutaneous nephrolithotomy.
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| Studies | Clavien Grade I | Clavien Grade II | Clavien Grade III | Clavien Grade IV | | Hegarty and Desai [19] (n=20) | Fever 5% | - | - | - | | Fei et al. [34] (n=55) | Nephrostomy tube displacement 1.89%
Fever 16.98% | Blood transfusion 7.54%
Non septic infections requiring additional antibiotics 3.78% | - | - | | Desai et al. [10] (n=773) | Fever 24.9% | - | Clavien Grade IIIb: Bowel injury 0.35% | - | | Zhao et al. [9]a (n=290) | Fever
Group 1: 13.1%
Group 2: 7.9% | Blood transfusion
Group 1: 3.4%
Group 2: 9.7%
SIRS
Group 1: 12.4%
Group 2: 6.2% | Angioembolization Group 1: 1.4%
Group 2: 4.1% | Septic shock
Group 1: four cases
Group 2: two cases | | Wong and Leveillee [13] (n=49) | Fever 12% | - | - | - | | Singla et al. [23] (n=149) | | Blood transfusion 30.8% | Hydrothorax 4.2%
Angioembolization 2.4%
Perinephric collection one case
Hemothorax one case | Clavien Grade IVa:
Urosepsis 5.3%
Clavien Grade IVb: Second look PCNL 18.2%
Double-J stenting 9.1% | | Annes et al. [15] (n=12) | - | Blood transfusion 8.3% | - | - | | Martin et al. [24] (n=166) | - | Blood transfusion
<20% in <2 punctures
41.6% in >3 punctures | - | - | | Hegarty and Desai [19] (n=20) | - | Blood transfusion 20% | - | - | | Lee et al. [31] (n=582) | - | - | Clavien Grade IIIb:
Colonic injury
Urinary extravasation 7.2% | - | | Aron et al. [14] (n=121) | - | - | - | Sepsis 0.97% |
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Complications (Clavien-Dindo classification).
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