Assessing the Efficacy of Mini-PCNL Versus Standard PCNL for Management of Staghorn Calculi >2cm: A Prospective Study in Peshawar

Abstract

Background: Staghorn stones pose a significant challenge in urology, given their complex nature and potential for causing substantial renal damage. Traditional management has often involved standard percutaneous nephrolithotomy (PCNL), known for its efficacy in stone clearance but also associated with considerable complication rates. Recent advancements have led to the development of mini-PCNL, aiming to reduce these complications while maintaining high stone clearance rates. Objective: This study aims to compare the efficacy, safety, and outcomes of standard and mini-PCNL in the management of staghorn stones, with a focus on complication rates, stone clearance, and hospital stay durations. Methods: A prospective study was conducted at the Institute of Kidney Diseases, Hayatabad, Peshawar, involving 162 patients undergoing PCNL for staghorn stones from January 2020 to December 2023. Patients were categorized into standard PCNL (n=69) and mini-PCNL (n=93) groups based on the procedural approach. Pre-operative, intra-operative, and post-operative data were collected, including patient demographics, stone size and density, operative findings, post-operative complications, and stone clearance rates. Statistical analysis was performed using SPSS version 25. Results: The mini-PCNL group demonstrated a significantly smaller average stone size (26.8 ± 5.8 mm) compared to the standard PCNL group (32.3 ± 10.3 mm, p=0.037). Single tract use was more prevalent in mini-PCNL (87.1%) than in standard PCNL (71.0%, p=0.016). Stone clearance rates were higher in the mini-PCNL group (87.1%) versus the standard group (73.9%, p=0.041). The average hospital stay was shorter for mini-PCNL patients (2.4 ± 1.0 days) compared to those undergoing standard PCNL (3.0 ± 1.1 days, p=0.030). Complications, including post-operative hematuria requiring transfusion, were more common in the standard PCNL group. Conclusion: Mini-PCNL offers a safer and more effective alternative to standard PCNL in the management of staghorn stones, with lower complication rates, higher stone clearance rates, and shorter hospital stays. These findings support the adoption of mini-PCNL as a preferred approach for managing complex renal calculi.