Current Role of Surgical Intervention versus Other Modalities in Management of Giant Renal Calculi (Partial and Complete Staghorn Calculi)

Abstract

O pen surgery for staghorn calculi has a higher stone free rate following the primary procedure (56.7%) versus PNL (46.7%). Furthermore, the stone free rate with open surgery was markedly increased with the use of intraoperative image (C-arm). The lack of flexible nephroscopy, the combined pneumatic/ ultrasonic or holmium laser for intracorporeal lithotripsy had a negative impact on the outcome of PNL for staghorn calculi. Accordingly, the need for secondary procedures (ESWL or secondary PNL) to address significant residual stones was higher with PNL (40%) versus the open surgery (26.7%). However, the need for adjunctive procedures (as double J removal or application) was higher in the open surgery group (56.7%) versus the PNL group (30%), a difference of significant value. PNL had the advantages of shorter hospital stay (a difference of high statistical significance) and shorter operative time.