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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