Introduction. Urolithiasis remains one of the major causes of hospitalization in urological departments. The development of endoscopic and minimally invasive technologies has expanded surgical treatment options for large, multiple and staghorn calculi of the upper urinary tract. Percutaneous nephrolitholapaxy is considered an effective approach for kidney stone removal, particularly in patients with calculi larger than 10 mm, when direct percutaneous access to the collecting system is required.
Objective. To evaluate the experience of using percutaneous nephrolitholapaxy for the surgical treatment of urolithiasis in the Urology Department of the Russian Railways-Medicine Clinical Hospital in Kirov from 2022 to 2024.
Materials and methods. This prospective single-center study included 90 patients aged 19 to 84 years with newly diagnosed or chronic urolithiasis who were admitted either electively or for urgent indications. The inclusion criteria were large upper urinary tract calculi located within the pyeloureteral junction, renal pelvis and calyces, including staghorn calculi. Patients with small calculi less than 10 mm were excluded. All patients underwent clinical, laboratory and instrumental evaluation, including ultrasound and multislice computed tomography of the urinary tract. All patients underwent surgical treatment by percutaneous nephrolitholapaxy.
Results. In 2022, 32 patients underwent surgery; in 2023, 26 patients; and in 2024, 32 patients. The study population included 44 men and 46 women. Over the study period, the number of patients with staghorn calculi increased from 2 cases in 2022 to 6 cases in 2023 and 14 cases in 2024. Multiple 10–25 mm calculi were reported in 5 patients in 2022, 5 patients in 2023 and 9 patients in 2024. The mean operative time was 60±15 min in 2022, 55±15 min in 2023 and 56±15 min in 2024. All procedures were completed with renal stenting. In total, 22 patients with staghorn calculi underwent surgery during the study period; postoperative evaluation showed no residual calculi in 18 of them, while 4 patients required a planned second-stage procedure with transurethral laser fibrocalicopyelolithotripsy.
Conclusion. The experience of the Urology Department of the Russian Railways-Medicine Clinical Hospital in Kirov demonstrates that percutaneous nephrolitholapaxy can be effectively used for large, multiple and staghorn renal calculi. This technique enables minimally invasive removal of upper urinary tract stones and may be considered an important component of surgical treatment for urolithiasis in a specialized urological hospital. Further analysis of stone-free rates, complications, length of hospital stay and the need for secondary procedures in all patient groups is required to provide a more comprehensive assessment of the efficacy and safety of this method.
