Category: Clinical Stones: PCNL

MP7-17 - Supine Percutaneous Nephrolithotomy for Staghorn Calculi

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Staghorn calculi present a challenge for endourologists. Clearance can take multiple procedures and multiple modalities with significant associated morbidity.


Methods :

We present our experience of supine percutaneous nephrolithotomy (sPNCL) for staghorn calculi performed at our a single university hospital, by two senior endourologists. Data were collected prospectively and entered in a pre-designed anonymised database.


Results :

74 patients underwent sPCNL for staghorn calculi between February 2007 and August 2016.


32 (43%) female and 42 (57%) male patients were included with a median age of 58 (range 18-82), median BMI of 27 (range 20-46) and median Charlson Comorbidity Index of 2.5 (0-8).


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).


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.


After a single procedure, stone clearance (residual fragments <2mm on CT 3 months postoperatively) was achieved in 39 (53%) of patients. 15 (20%) complications (Clavien-Dindo Grade II or above) were encountered including 7 (10%) UTI/sepsis and 2 (3%) bleeding requiring transfusion.


Conclusions :

PCNL for staghorn calculi is feasible in the supine position, however patients must be appropriately counselled regarding possible requirement for multiple procedures to achieve clearance.

John Withington

Urology Registrar
Royal Free Hospital NHS Trust
London, England, United Kingdom

Masood Moghul

Urology Registrar
Royal Free Hospital NHS Trust
st albans, England, United Kingdom

Masood Moghul MRCS, PgDip, MBBS, BSc (Hons.), AKC
Urology SpR, London

Darrell Allen

Consultant Urologist
Royal Free Hospital NHS Trust
London, England, United Kingdom

Leye Ajayi

Consultant Urologist
Royal Free Hospital NHS Trust
London, England, United Kingdom