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Minerva Urologica e Nefrologica 2020 Dec 01

DOI: 10.23736/S0393-2249.20.04124-7


lingua: Inglese

Non-papillary percutaneous nephrolithotomy for treatment of staghorn stones

Panagiotis KALLIDONIS 1 , Athanasios VAGIONIS 1, Marco LATTARULO 1, 2, Constantinos ADAMOU 1, Arman TSATURYAN 1, Despoina LIOURDI 3, Theofanis VRETTOS 4, Claudio SIMEONE 2, Evangelos LIATSIKOS 1

1 Department of Urology, University Hospital of Patras, Patras, Greece; 2 Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 3 Department of Internal Medicine, Ag. Andreas Hospital, Patras, Greece; 4 Department of Anesthesiology and Intensive Care, University Hospital of Patras, Patras, Greece


BACKGROUND: To evaluate the non-papillary puncture for Percutaneous Nephrolithotomy (PCNL) for the treatment of staghorn stones in terms of safety and efficacy.
METHODS: Data of 53 patients undergoing PCNL for staghorn stones were retrospectively collected from January 2015 to December 2019. A non-papillary puncture was performed with a two- step track dilation technique up to 30Fr. A 26 Fr semirigid nephroscope and an ultrasonic lithotripter with integrated suction (Swiss Lithoclast master, EMS S.A, Switzerland) were used for the treatment. Demographics and perioperative data were retrospectively gathered from an institutional board approved database.
RESULTS: The average stone size was 60.1±16.1 mm. Mean operative time was 54.57±14.83 minutes, while mean time using fluoroscopy was 2.67±1.02 minutes. Mean number of accesses was 1.2 (a total of 64 accesses). Flexible nephroscope was never used. Primary stone-free rate after PCNL was 81.1% (43 patients). Mean hemoglobin drop was 1.6±1.86 gr/dl. Overall patient stay was 3.94±0.82 days, while overall complication rate was 20.7% (11 patients), with only one patient requiring blood transfusion due to pseudoaneurysm.
CONCLUSIONS: The use of non-papillary access for PCNL in the treatment of staghorn stones resulted in promising results in terms of stone-free rate, operating time, complication rate, hemoglobin drop and reduced the number of percutaneous tracts. These parameters of the current investigation were directly comparable to current literature. The safety and efficacy of a non-papillary approach for the treatment of staghorn stones could be advocated.

KEY WORDS: PCNL; Stone disease; Lithotripsy; Non-papillary access; Urolithiasis

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