Introduction

Clearing staghorn calculi can take multiple procedures and multiple modalities with significant associated morbidity. In order to evaluate the safety and effectiveness of sPCNL for staghorn stones, we prospectively recorded patient characteristics, operative details and outcomes of these cases over a nine-year period. _x000D_

Methods

We present our experience of supine percutaneous nephrolithotomy (sPNCL) for staghorn calculi performed at a single tertiary referral endourology unit, by two senior endourologists. Data were prospectively recorded in a pre-designed anonymised database._x000D_ Basic demographic information, detailed radiological information regarding stone size, number and position and comorbid information were entered, followed by post-operative entry of operative detail, stone clearance, following CT imaging, within 3 months post-sPCNL and complications, were graded according to the Clavien-Dindo classification._x000D_

Results

74 patients underwent sPCNL for staghorn calculi between February 2007 and August 2016. These included 32 (43%) female and 42 (57%) male patients, with a median age of 58 (range 18-82), median BMI of 27 (20-46) and median Charlson Comorbidity Index of 2.5 (0-8)._x000D_ 13 (18%) of patients had partial staghorn and 61 (82%) had complete staghorn calculi. Median stone density on CT was 970 Hounsfield Units (306-2032). _x000D_ Multiple access tracts were used in 9 (12%) patients. 43 (58%) had primary access in the lower pole, 17 (23%) in the interpolar region and 14 (19%) in the upper pole. Median operative time was 90 minutes (35-240). 50 (68%) patients had a ureteric stent placed intraoperatively._x000D_ After a single procedure, stone clearance (residual fragments <2mm on CT, within 3 months postoperatively) was achieved in 39 (53%) of patients. 15 (20%) complications (Clavien-Dindo Grade II or above) were recorded, including 7 (10%) UTI or sepsis and 2 (3%) bleeding requiring transfusion._x000D_

Conclusions

sPCNL for staghorn calculi is safe and effective in appropriately selected and counselled patients. In particular, patients should be advised that multiple procedures may be required in order to achieve clearance and that complication rates, including bleeding and infection are higher than for less complex stones. _x000D_

Funding

none