Material and Methods:
This is a retrospective analysis of patients who underwent PCNL for
staghorn renal stones at the Ministry of Health Izmir Bozyaka Training
and Research Hospital between April 2011 and January 2017. All the data
of the patients were obtained from their electronic medical records.
Patients with a history of neuromuscular disease, congenital kidney
anomalies, coagulopathy, skeletal deformity, and solitary kidneys, cases
requiring multiple accesses, and patients without staghorn stones were
excluded from the study. A total of 182 staghorn stones were divided
into two groups according to patient age: those aged <65 years
old were defined as Group-1 and those aged ≥65 years as Group-2. The
demographic, perioperative and postoperative data were compared between
these two groups.
All the patients were evaluated preoperatively using standard
non-contrast abdominal computed tomography (CT). The patients’
demographic characteristics such as gender and body mass index, and
preoperative characteristics, including operation side and history,
stone burden, metabolic syndrome (presence of at least two of the
following diseases: diabetes mellitus, hypertension, hyperlipidemia
and/or obesity), and stone density were recorded. In addition,
intraoperative and postoperative results (operation time, fluoroscopy
time, nephroscopy time, length of hospital stay, calyx accessed,
complications, and stone-free status) were examined. Postoperative
complications were evaluated according to the Clavien scoring system (8)
and divided into two groups as minor (grades I and II) and major (grades
III to V).
After the urine culture of the patients was confirmed to be negative,
they were taken to the operation room. Ceftriaxone was administered to
the patients as prophylaxis before the operation and continued until the
nephrostomy tube was removed. No nephrotoxic drug was used in any of the
patients before, during or after the operation.
Stone burden was calculated in square millimeters in all patients
(length x width x π x 0.25, where 3.14 was taken as the mathematical
constant) (9). For staghorn stones, this calculation was performed
separately for each calyceal stone and the sum of all values was
accepted as the result. All PCNL operations were performed by
experienced urologists. Success was considered as complete stone-free
status or detection of <4 mm stones on control CT performed at
the first postoperative month.