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The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome

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Abstract

The objective of this study was to analyze the outcome of percutaneous nephrolithotomy (PCNL), laparoscopic and open anatrophic nephrolithotomy (AN) for management of patients with large staghorn renal stones. We analyzed the peri-operative parameters, overall treatment costs and changes in the function of the affected kidney on technetium-99 dimercaptosuccinic acid renal scintigraphy, done before the operation and before the final follow-up visit, in 45 adults who underwent PCNL (n = 16) versus laparoscopic (n = 15) versus open (n = 14) AN for large staghorn renal stones. All three groups had statistically similar preoperative characteristics, including the function of the operated kidney on renal scan. On the discharge day, the PCNL group had the lowest stone-free rate (43.75 %) compared to the laparoscopic (80 %) and open AN groups (92.85 %) (P = 0.009). After a mean follow-up period of 12.1 months, the decrease in the function of the operated kidney was greatest in the open AN group (−8.66 ± 4.97) compared to the laparoscopic AN (−6.04 ± 6.52) and PCNL group (−2.12 ± 2.77) (P = 0.003). The need for ancillary procedures to manage residual stones was greatest in the PCNL group and lowest in the open AN group. A similar trend was seen in overall treatment costs (P < 0.001). For management of large staghorn renal stones, the more invasive the procedure, the higher the one-session stone-free rate and the lower the need for ancillary procedures; however, greater renal functional loss can be anticipated. The need for ancillary procedures is a major determining factor in the overall cost of treatment, which was highest in the PCNL group.

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Acknowledgments

This work was supported by Shiraz University of Medical Sciences. This report is based on research done in partial fulfillment of the requirements for the specialty degree in Urology (No. 91-01-01-4467) awarded to Dr. Masoumi. We thank K. Shashok (Author AID in the Eastern Mediterranean) for improving the use of English in the manuscript.

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Authors and Affiliations

  1. Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Zand Street, P.O. Box 71344, Shiraz, Iran

    Alireza Aminsharifi, Dariush Irani, Mansour Masoumi, Bahman Goshtasbi & Reza Mohamadian

  2. Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Alireza Aminsharifi

  3. Toronto General Hospital, Toronto, Canada

    Amirhossein Aminsharifi

Authors
  1. Alireza Aminsharifi
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  2. Dariush Irani
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  3. Mansour Masoumi
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  4. Bahman Goshtasbi
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  5. Amirhossein Aminsharifi
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  6. Reza Mohamadian
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Correspondence to Alireza Aminsharifi.

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All authors have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Shiraz University of Medical Sciences research committee and with the 1964 Helsinki declaration and its later amendments.

Funding

This study was supported by Shiraz University of Medical Sciences (Grant No. 91-01-01-4467).

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Aminsharifi, A., Irani, D., Masoumi, M. et al. The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome. Urolithiasis 44, 551–557 (2016). https://doi.org/10.1007/s00240-016-0877-6

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  • DOI: https://doi.org/10.1007/s00240-016-0877-6

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