The management of complete staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: A comparative analysis of clinical efficacy and intermediate-term functional outcome

Introduction and Objective: To analyze the outcome of percutaneous nephrolithotomy (PCNL), laparoscopic and open anatrophic nephrolithotomy (AN) for the management of patients with large staghorn renal stones.

Methods: We analysed the perioperative 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.

Results: All three groups had statistically similar preoperative characteristics including the function of the operated kidney on the 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).

Conclusion: 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, a 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.

Keywords: Percutaneous nephrolithotomy, Laparoscopy; Nephrolithotomy, Anatrophic nephrolithotomy, Staghorn renal calculi, renal stone