Complex management of staghorn renal stones
Mészáros Máté dr., Anik Mercédesz Amelita dr., Fábos Zoltán dr., Szántó Árpád dr., Jávorházy András dr.
Pécsi Tudományegyetem KK, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
Introduction: Percutan nephroltihotomy (PCNL) is the standard procedure for partial and complete staghorn calculi. Although the evolution of endoscopic equipment improves success rate, the management of staghorn renal stones are still challenging. Patients with GSS3 and GSS4 stones who underwent stone management were retrospectively evaluated. The primary aim of this research was to investigate the complex management of staghorn renal stones with PCNL surgery and additional ESWL and chemolytic treatment. The practical use of Guy’s Stone Score as a predictor of success and complications in stone management was also evaluated.
Patients and methods: Retrospectively in 60 patients 62 ’renal stone-unit’ were evaluated and divided into GSS3 (38 cases) and GSS4 (24 cases) groups between January 2013 and October 2020 in the Department of Urology, University of Pécs. During this research period 79 conventional PCNL surgery was performed. In almost quarter of the cases (22.6%) repeated surgery was needed. In the case of clinically significant residual fragments ESWL treatments were done in 26 cases (41.9%) and in 5 patients (8%) with uric acid stones additional chemolysis was applied. The complication rates of the surgery and the achieved stone free rates with complex therapy were compared between the two patient groups.
Results: In the GSS3 group 20 patients (52.6%) became totally stone free after PCNL surgery, and with additional ESWL therapy another 10 patients (34.2%). In the case of uric acid stones chemolysis was effective in another 3 patients (7.9%). In the GSS4 group 8 patients (33%) was stone free after PCNL surgery and with additional ESWL therapy further 6 patients (25%) achieved stone free status. Evaluating the two groups together the stone free rate was 45.2% after PCNL surgery, but with additional therapy it reached 75,8%. The complication rate was higher with 15.4% in the GSS4 group. The 42% of the evaluated patients had infection stones.
Conclusion: Stone free status was reached just by surgery in less than half of the cases, in the other cases prolonged additional treatment was needed. ESWL treatment or – in the case of uric acid stones – oral chemolytic therapy of the residual stones were also effective. In the end, three-quarters of patients with staghorn calculi became stone free. Guy’s Stone Score shows correlation with the outcome of PCNL surgery and it is beneficial for patient information or surgical planning in everyday practice. Patients with infection stones have a higher risk for postoperative fever and sepsis, that’s why preoperative urine culture and antibiotic prophylaxis are essential.