Perioperative and long-term results of ultrasonography-guided single- and multiple-tract percutaneous nephrolithotomy for staghorn calculi

Rui-Xiang Cheng; Ni Dai; Yan-Min Wang; Pei Qi; Fen Chen

doi:10.12998/wjcc.v12.i7.1243

Perioperative and long-term results of ultrasonography-guided single- and multiple-tract percutaneous nephrolithotomy for staghorn calculi

World J Clin Cases. 2024 Mar 6;12(7):1243-1250. doi: 10.12998/wjcc.v12.i7.1243.

Authors

Rui-Xiang Cheng¹, Ni Dai², Yan-Min Wang³, Pei Qi⁴, Fen Chen⁵

Affiliations

¹ Department of Urology, Wuhan Ninth Hospital, Wuhan 430081, Hubei Province, China.
² Department of Urinary Pain, Wuhan Hankou Hospital, Wuhan 430000, Hubei Province, China.
³ Pre-hospital Emergency Department, Wuhan Puren Hospital, Wuhan 430081, Hubei Province, China.
⁴ Department of Orthopedic Trauma Surgery, Wuhan Hankou Hospital, Wuhan 430000, Hubei Province, China.
⁵ Department of Ultrasound, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan 430015, Hubei Province, China. fchen0919@163.com.

Abstract

Background: It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention. Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy (M-PCNL) has a similar stone free rate (SFR) as standard percutaneous nephrolithotomy (S-PCNL). As a result, M-PCNL was also recommended as a treatment option for staghorn calculi.

Aim: To examine the perioperative and long-term results of ultrasonography-guided single- and M-PCNL.

Methods: This was a retrospective cohort study. Between March 2021 and January 2022, the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy. The primary outcomes were complication rate and SFR, and the characteristics of patients, operative parameters, laboratory measurements were also collected.

Results: In total, 345 patients were enrolled in the study (186 in the S-PCNL group and 159 in the M-PCNL group). The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group (P = 0.033). Moreover, the incidence rates of hydrothorax (P = 0.03) and postoperative infection (P = 0.012) were higher in the M-PCNL group than in the S-PCNL group. Logistic regression analysis demonstrated that post-operative white blood cell count (OR = 2.57, 95%CI: 1.90-3.47, P < 0.001) and stone size (OR = 1.59, 95%CI: 1.27-2.00, P < 0.001) were associated with a higher overall complication rate in the S-PCNL group. Body mass index (OR = 1.22, 95%CI: 1.06-1.40, P = 0.004) and stone size (OR = 1.70, 95%CI: 1.35-2.15, P < 0.001) were associated with increased overall complications in the M-PCNL group.

Conclusion: Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.

Keywords: Multiple-tract percutaneous nephrolithotomy; Single-tract percutaneous nephrolithotomy; Staghorn calculi; Ultrasonography.