Ultrasound-guided percutaneous nephrolithotomy for management of renal complete staghorn stones

Objective To assess the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL) with ultrasonic and pneumatic lithotripters for complete renal staghorn stones. Methods From January 2006 to January 2015, 128 patients (142 kidneys) with complete staghorn stones underwent PCNL, included 14 patients with bilateral renal complete stones, 13 patients with solitary or founctional solitary kidney, 22 patients with renal insufficiency, 25 patients with renal empyema, 4 patients with spine malformation, ultrasound-guided PCNL were performed. Stones were fragmented and cleared using a combination of ultrasonic and pneumatic lithotripters. Results All PCNL procedures were successful. Successful access to the collecting system was 100%. Mean operation time was (64.5±39.1) minutes (range 30-150 minutes). The primary stone-free rate of PCNL was 76.8% (109/142). Most of the renal stones (63.4%, 90/142) were managed satisfactorily by a single tract, a second tract was used in 25 renal stones (17.6%, 25/142). There were 36 auxiliary procedures (24 second PCNL and 3 third PCNL and 9 extracorporeal shock wave lithotripsy). One month after treatment, the overall stone-free rate was 85.2% (121/142). Six patients (4.2%) received blood transfusion, three patients (2.1%) received angiography and embolization. Three patients (2.1%) with septic shock were cured by intravenous antibiotics and antishock treatments. Three patients with temporary renal function receded were observed in solitary kidney for two tracts PCNL. No other severe complications occurred. The mean postoperative stay was 5.2 days (range 2-12 days). Conclusion Ultrasound-guided PCNL with ultrasonic and pneumatic lithotripters for management of renal complete staghorn stones is safe and effective. Key words: Kidney calculi; Ultrasonography, interventional; Percutaneous nephrolithotomy; Ultrasonic and pneumatic lithotripters.