Management Of Staghorn Calculi Research Articles

International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management.

The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis. To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones. A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion. The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document. A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.

Conservative management of staghorn stones.

Since the seminal works by Singh and Blandy in the 1970s, the management of staghorn stones has almost exclusively involved surgical intervention. In contrast, a more recent study found that conservative management was not as unsafe as previously believed. The present review sought to examine the available literature to understand the implications of a conservative strategy. A systematic search of the literature was carried out using MEDLINE®, Embase™ and the Cochrane Central Register of Controlled Trials. All papers looking at management of staghorn calculi were reviewed and studies with a conservative management arm were identified. Outcomes of interest were recurrent or severe urinary tract infections, progressive renal deterioration, dialysis requirements, morbidity and disease specific mortality. Owing to the lack of relevant data, a descriptive review was carried out. Our literature search yielded 10 suitable studies involving a total of 304 patients with staghorn stones managed conservatively. Progressive renal deterioration occurred in 0-100% of cases (mean 27.5%) with a higher rate among bilateral staghorn sufferers (44% vs 9%). Dialysis was required in 9% of patients (20% bilateral, 6% unilateral). The mean rate of severe infection was 8.7% and recurrent urinary tract infections occurred in as high as 50% of cases (80% bilateral, 41% unilateral). Disease specific mortality ranged from 0% to 67% (mean 20.5%). It appears that conservative management of staghorn calculi is not as unsafe as previously thought and selection of patients with unilateral asymptomatic stones with minimal infection should be considered.

Contemporary best practice in the management of staghorn calculi.

Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging. Fortunately, advances in technology and endourology techniques have enabled urologists to effectively treat these stones with minimal morbidity to the patient. This article describes the contemporary best practices in the initial evaluation, management, and follow up of patients with staghorn calculi to help the practicing urologist navigate this complex condition.

Perioperative and long-term results of retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for staghorn calculi: a single-center randomized controlled trial.

To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi. From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups. Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6months. PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.

114 - Does stone compositions influence percutaneous nephrolitotomy in the management of staghorn calculi?

114 - Does stone compositions influence percutaneous nephrolitotomy in the management of staghorn calculi?

Response to Hamilton et al. re: Conservative Management of Staghorn Calculi: When Is It Safe? by Morgan et al.

Response to Hamilton et al. re: Conservative Management of Staghorn Calculi: When Is It Safe? by Morgan et al.

Three-Dimensional Laparoscopic Anatrophic Nephrolithotomy

Abstract Introduction: The management of staghorn calculi and complete clearance remains technically challenging. Extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, or a combination therapy has limited efficacy. The stone-free status may require several sessions of these procedures and might result in considerable morbidity. We had done laparoscopic anatrophic nephrolithotomy for a large staghorn calculi with complete stone clearance in a single operative session with preserved renal function. In this video presentation, we show our technique of transperitoneal anatrophic nephrolithotomy for staghorn calculi. Materials and Methods: A 64-year-old male presented with right flank pain for 6 months duration and fever on and off for 4 months. CT urogram showed right staghorn calculus measuring 5.3 × 4.5 cm (HU up to 797) without hydronephrosis. The patient was taken for right anatrophic nephrolithotomy, right RGP and Double-J were placed before placing the patient in left lateral decubitus pos...

Role of open surgery in the management of staghorn calculus

Objective: To evaluate the role of open surgery in the management of staghorn calculi by comparing it with other available modalities of treatment i.e. percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) and assessing improvement in the renal function (parenchymal thickness & glomerular filteration rate (GFR) after stone removal. Design: Institutional- based prospective study. Place and Duration of study: This study was conducted at the department of Urology, Nishter hospital, Multan from January 2000 to February 2002 (2 years). Subjects & Methods: A total of fifty patients with staghorn calculi who underwent open surgery in the department & completed a three-month follow-up were included in the study. All patients had a complete blood examination (CBE), complete urine examination (CUE) (including culture & sensitivity (CIS), renal parameters (urea & creatinine), renal tract ultrasonography (USG) preoperatively & at first, second & third month of follow-up to assess the improvement in heamoglobin, control of urinary tract infection (UTI), parenchymal thickness & postoperative complications. Tc99m DTPA scan was employed before surgery & at third month of follow-up to evaluate the improvement in GFR for operated kidney. Results: The male to female ratio was 2.1:1, with a mean age of presentation of 42.70 years. Pain in the lumbar region (58%) was the most common presentation followed by lower urinary tract symptoms (LUTS 32%) & renal insufficiency (16%). Fever (36%) was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. It fell to 10.21 gm at first month of follow-up but increased to 11.89 gm by the third month. . The mean GFR before surgery was 77.18ml/min, which increased to 81.56ml/min after surgery at third month of follow-up. The mean GFR of the kidney with stones was 32.46 ml/min before surgery, which increased to 39.84-ml/ min after surgery. Conclusion: Staghorn stones if left untreated lead to chronic UTI & renal insufficiency. Removal of the stone is the only way these consequences can be avoided. Nonavailability of resources, a poor health care system, the lack of PCNL & ESWL facilities &/or expertise, the cost & need for multiple sessions &/or ancillary procedures in these minimally invasive techniques & the vigorous follow-up required still make open surgery a viable & an applicable option in our socioeconomic setup.

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

Infectious Outcomes of Nephrostomy Drainage before Percutaneous Nephrolithotomy Compared to Concurrent Access

We hypothesized that establishing percutaneous nephrostomy drainage and treating with renal urine culture specific antibiotics would lead to a decreased sepsis rate in patients at increased risk for infection. We analyzed the experience of a single surgeon with sepsis after percutaneous nephrolithotomy following prior nephrostomy drainage compared to percutaneous nephrolithotomy with concurrent percutaneous renal collecting system access. We retrospectively reviewed the records of patients who underwent percutaneous nephrolithotomy. Pertinent collected data included patient infection history, preoperative urine cultures, renal calculi burden size, renal urine/stone cultures, length of stay and sepsis/systemic inflammatory response syndrome events. Percutaneous nephrolithotomy was performed in 219 patients between September 2007 and June 2012. Of the patients 67 (30.6%) had preplaced nephrostomy drainage (group 1) while 152 (69.4%) had concurrent percutaneous renal access (group 2). Stone culture was positive more often in group 1 than in group 2 (64.2% vs 25.7%, p = 0.0001). The concordance rate of preoperative renal urine culture results with stone culture results was higher than the concordance rates of lower urinary tract urine culture results in groups 1 and 2 (30.6% vs 21.4% and 7.3%, respectively). There was no systemic inflammatory response syndrome/sepsis episode in group 1 but we noted a 5.9% systemic inflammatory response syndrome/sepsis rate in group 2 (p = 0.043). In this retrospective study our data suggest that in patients at high risk for urosepsis preoperative nephrostomy drainage with renal urine culture and culture specific antibiotic treatment may decrease the risk of postoperative infectious complications. Stone culture is also important since many patients athigh risk for infection will have positive stone cultures. A prospective study isneeded to confirm these retrospective data findings.

Factors Affecting Complication Rates of Percutaneous Nephrolithotomy in Children: Results of a Multi-Institutional Retrospective Analysis by the Turkish Pediatric Urology Society

We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

Isolated Upper Pole Access in Percutaneous Nephrolithotomy: A Large-Scale Analysis from the CROES Percutaneous Nephrolithotomy Global Study

We analyzed the indications for and outcomes of percutaneous nephrolithotomy using upper pole access. Between 2007 and 2009 prospective data were collected by the Clinical Research Office of the Endourological Society (CROES) from consecutive patients at 96 centers globally. Data on 4,494 patients were included in this analysis. Patients were divided into upper and lower pole access groups based on the location of percutaneous renal access. Preoperative characteristics and outcomes were compared between the 2 groups by univariate and multivariate tests. The upper pole access group had more staghorn stones (21.7% vs 15.5%, p <0.001) and a greater stone burden (mean ± SD 476 ± 390.5 vs 442 ± 344.9 mm(2), p = 0.091). Mean operative time was 92.4 ± 46.1 and 75.1 ± 41.3 minutes in the upper and lower pole groups, respectively (p <0.001). The stone-free rate was lower in the upper pole access group (77.1% vs 81.6%, p = 0.030). The overall complication rate was higher in the upper pole group with a higher incidence of hydrothorax (5.8% vs 1.5%) but a lower incidence of pelvic perforation (1.8% vs 3.2%). Mean hospital stay was longer in the upper pole group (p = 0.048). Success and complication rates were similar in upper pole access subgroups, defined as definitive (staghorn and isolated upper calyceal stones) and elective (pelvic, middle calyceal and lower pole stones) indications. Isolated upper pole access is indicated in a select group of patients with complex stones. Upper calyceal and staghorn stones are more commonly managed by upper pole access, which is associated with a higher complication rate and longer hospital stay as well as a lower stone-free rate due to procedure complexity.

Efficacy and safety of percutaneous nephrolithotomy for treatment of staghorn stones in solitary kidney

To analyze efficacy and safety of percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi with solitary kidney. Between April 2009 and December 2011, 13 patients with renal staghorn calculi in solitary kidney were treated by PCNL in our hospital. The therapeutic effects and complications were the main points of the analysis. Of the 13 patients, surgery time was 92-164 (117.2±21.5) min; 9 cases underwent PCNL through a single access tract, 4 cases through multi-access tracts. The stone removal rate in one session of PCNL was 76.9%, and the total clearance rate was 92.3%. Hemoglobin dropped 11-32 (16.4±4.6) g/L; one case required blood transfusion; no patient had embolism. Hospital stay was 5-10 (6.9±1.5) days postoperatively. Serum creatinine before PCNL in these patients was 83-237 (146.24±38.73) μmol/L compared to 81-242 (134.56±21.52) μmol/L by the end of the 1-month follow-up period (not statistically different). Similar findings were observed in glomerular filtration rates: before PCNL it was 42-114 (71.32±20.82) mL/min and by the end of the 1-month follow-up it was 55-117 (79.40±22.14) mL/min (not statistically different). PCNL is effective and safe for the treatment of staghorn stones in solitary kidney, and has advantages such as short surgical duration, fewer complications, rapid recovery, short hospital stay, effective stone removal rate, and so on.

Editorial Comment

The American Urological Association Guidelines recommend percutaneous nephrolithotomy (PCNL) as the standard of care for patients with staghorn or large renal stones because of the high stone-free rates (SFRs) with minimal morbidity. 1 Preminger G.M. Assimos D.G. Lingeman J.E. et al. AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005; 173: 1991-2000 Abstract Full Text Full Text PDF PubMed Scopus (725) Google Scholar Before the advent of flexible fiberoptic instruments and Holmium laser lithotripters, it was not unusual for PCNL to require multiple access tracts directly on calyces containing stones to achieve stone-free status. Some authors even suggested performing auxiliary procedures, such as shock wave lithotripsy (SWL) as combination or “sandwich” therapy with PCNL to fragment stones that could not be reached using rigid instruments. However, SFRs were lower when SWL was not followed with PCNL to remove stone fragments. With the invention of flexible nephroscopes and ureteroscopes in addition to the availability of flexible miniaturized lithotripters, such as Holmium laser using 200- or 365-μm fibers, PCNL through a single incision and a single tract (sPCNL) becomes possible for large renal stones and even staghorns. In the above manuscript, the authors present a retrospective series of 351 patients who underwent sPCNL from 2000 to 2010. 2 Shahrour K, Tmoaszewski J, Ortiz T, et al. Predictors of immediate post-operative outcome of single-tract percutaneous nephrolithotomy. Urology. 17057. Google Scholar Although this method was first proposed by Wong and Leveillee, 3 Wong C. Leveillee R.J. Single upper-pole percutaneous access for treatment of ≥ 5-cm complex branched staghorn calculi: is Shock wave lithotripsy necessary?. J Endourol. 2002; 16: 477-481 Crossref PubMed Scopus (84) Google Scholar the authors should be commended for their meticulous collection of data over the 10-year period. In addition to limiting the incision to a single site (laparo-endoscopic single site [LESS), they also used a flexible ureteroscope through a natural orifice (urethra) during second-look nephroscopy to access calyces inaccessible using a flexible nephroscope; thus combining LESS with natural orifice transurethral endoscopic surgery (NOTES). Predictors of Immediate Postoperative Outcome of Single-tract Percutaneous NephrolithotomyUrologyVol. 80Issue 1PreviewTo evaluate the efficacy of single tract percutaneous nephrolithotomy (sPCNL) and investigate the preoperative predictive factors associated with stone clearance after sPCNL. Full-Text PDF

Practice Variation in the Surgical Management of Urinary Lithiasis

Shock wave lithotripsy and ureteroscopy are highly effective treatments for urinary lithiasis. While stone size and location are primary determinants of therapy, little is known about other factors associated with treatment. We identified patient, provider and practice setting characteristics associated with the selection of ureteroscopy or shock wave lithotripsy. We used the Medicare 5% sample to identify beneficiaries with an incident stone encounter from 1997 to 2007. Within this group we identified beneficiaries undergoing shock wave lithotripsy or ureteroscopy for the management of urinary calculi. Multivariable regression models identified factors associated with the use of ureteroscopy. The cohort comprised 9,358 beneficiaries who underwent an initial procedure. Shock wave lithotripsy was used in 5,208 (56%) beneficiaries while ureteroscopy was used in 4,150 (44%). Female patients were less likely than males to undergo ureteroscopy (OR 0.844, p = 0.006). Providers who more recently completed residency training used ureteroscopy more often (p = 0.023). Provider and facility volume were associated with initial procedure selection. The odds of a second procedure following initial shock wave lithotripsy were 1.54 times those of ureteroscopy (p <0.001). Nonclinical factors are associated with the use of ureteroscopy or shock wave lithotripsy for initial stone management, which may reflect provider and/or patient preferences or experience. Further investigation is required to understand the impact of these outcomes on quality and cost of care.

Comparison of Outcomes After Percutaneous Nephrolithotomy of Staghorn Calculi in Those with Single and Multiple Accesses

To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi. The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed. The mean number of percutaneous accesses was 2.42 +/- 0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P = 0.002, P < 0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P = 0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P < 0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03 mg/dL and 1.08 mg/dL in group 1, and 0.9 mg/dL and 1.03 mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P = 0.16). The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi.

A Prospective, Randomized Trial of Management for Asymptomatic Lower Pole Calculi

We determined the natural course and compared the deleterious effects in kidneys of shock wave lithotripsy, percutaneous nephrolithotomy and observation for asymptomatic lower caliceal stones. Between April 2007 and August 2008 patients with asymptomatic lower caliceal calculi were enrolled in the study. To assess stone status noncontrast abdominal helical computerized tomography was done 3 and 12 months after intervention. All patients were evaluated by dimercapto-succinic acid renal scintigraphy 6 weeks and 12 months after intervention. A total of 94 patients were prospectively randomized to percutaneous nephrolithotomy (31), shock wave lithotripsy (31) and observation (32). Mean +/- SD followup was 19.3 +/- 5 months (range 12 to 29). In the percutaneous nephrolithotomy group all patients were stone-free at month 12. Scintigraphy revealed a scar in 1 patient (3.2%) on month 3 followup imaging. In the shock wave lithotripsy group the stone-free rate was 54.8%. Scintigraphy revealed scarring in 5 patients (16.1%). In the observation group 7 patients (18.7%) required intervention during followup. Median time to intervention was 22.5 +/- 3.7 months (range 18 to 26). One patient (3.1%) had spontaneous stone passage. Scintigraphy did not reveal scarring in any patient. Stone related events were noted in more than 20% of patients with asymptomatic lower caliceal stones observed expectantly. To manage lower caliceal stones percutaneous nephrolithotomy has a significantly higher stone-free rate with less renal scarring than shock wave lithotripsy. Thus, patients with asymptomatic lower caliceal stones must be informed in detail about all management options, especially focusing on percutaneous nephrolithotomy with its outstanding outcome.

Percutaneous Nephrolithotomy for Staghorn Calculi: A Single Center's Experience over 15 Years

Percutaneous nephrolithotomy (PCNL) for staghorn calculi is one of the more challenging endourologic procedures. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. The purpose of this study was to evaluate the outcomes of PCNL for patients with staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Between July 1990 and December 2005, 1338 patients underwent PCNL for renal stone disease at our institution. Among this group, 509 procedures were performed for patients with a partial or complete staghorn calculus. Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other early and late complications, and stone-free status. Mean patient age was 53.8 years (range 4-84 yrs). The average procedure time was 104 minutes. Sixteen percent of the cases needed multiple access tracts (range 2-5), with the lower calix being the most commonly used in 64.1%, followed by the upper calix in 18.5% and the middle calix in 17.4%. Various intracorporeal lithotriptors were used, including ultrasound, pneumatic, electrohydraulic, and holmium:yttrium-aluminium-garnet laser. The transfusion rate among this group was 0.8%. There was no statistically significant difference in transfusion rates (0.7%-1.2% P = 0.24) or other major complications in patients who were treated with either a single tract or among those needing multiple tracts. Stone-free rates at hospital discharge and at 3 months follow-up were 78% and 91%, respectively. PCNL is a safe and effective procedure in the management of staghorn calculi, with outcomes similar to those reported for percutaneous management of smaller volume nonstaghorn stones. Attention to accurate tract selection and placement as well as possession of the full array of endourologic equipment are essential to achieving an excellent outcome.

S103 Outcome of percutaneous management of staghorn calculi: can the access number be predicted?

S103 Outcome of percutaneous management of staghorn calculi: can the access number be predicted?

Management of staghorn calculus: single puncture with judicious use of the flexible nephroscope

To focus on the technique and results of a single percutaneous puncture for the management of staghorn renal calculi. The success rate for treating staghorn calculi with a single percutaneous puncture is over 90%. Animal and clinical studies seem to suggest that a single percutaneous access may be associated with reduced morbidity when compared with multiple percutaneous access punctures. A single percutaneous access, whenever feasible, offers reduced morbidity without compromising excellent stone-free rates in the management of staghorn calculi.