Evaluation of the efficacy of multiple-access endoscopic surgery for staghorn and multiple nephrolithiasis

Nasirov F.R., Mirhamidov D.H., Alidzhanov Zh.F., Giyasov Sh.I., Nuraliev T.Yu., Yuldashev Zh.M., Muhtarov Sh.T., Akilov F.A.

Background. Despite of recent advances in the development of endoscopic treatment for staghorn nephrolithiasis, stone-free rates after percutaneous nephrolithotomy (PNL), still remaining lower comparing to other types of renal stones. Multiple access approach of percutaneous surgery for renal stones thus may be another cost-effective procedure.

Patients and methods. Data of 30 patients underwent multiple-access PNL due to staghorn and multiple nephrolithiasis was investigated. Mean age of patients was 29.3±11.9 years. We evaluated duration of the intervention, stone free rate, duration of hospital stay, rate and severity of periand postoperative complications, etc. Comparative analysis was performed using Student’s t and Fisher exact tests. Strength of associations was assessed using Spearman’s rank correlation coefficient (rho). Value of р< 0.05 was considered as statistically significant.

Results. Mean duration of intervention was 110.7±34.9 min and reliably (р< 0.05) depended of number of stones (r=0.45). Stone-free status was achieved in 20 (66,7%) patients. Residual stones were revealed in 10 (33,3%) patients. In 3 cases (10%), interventions were finished totally tubeless, in 11 (36,7%) – with the installation of single nephrostomic tube, in 14 (46,7%) cases with two, and in 2 cases (6,7%) – three tubes were installed into renal sinuses. Intraoperative bleeding occurred in 3 (10%) cases and mean volume of blood loss was assessed to be equal to 276.7±25.2 cc. Postoperative complications were revealed in 7 (23.3%) patients: postsurgical hemorrhage in 2 (28.6%), and manifestation of symptomatic hospitalacquired UTIs in 5 (71.4%) patients.

Conclusion. Single-step multiple-access PNL allows to reach stone-free rate almost in 67% of cases of multiple and staghorn nephrolithiasis and its efficacy is as high as 90%.

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