Category: Clinical Stones: Outcomes
Introduction & Objective :
Percutaneous nephrolithotomy (PCNL) is a well-established treatment for staghorn stones. Given the improvement in technology and techniques of flexible ureterorenoscopic lasertripsy (FURS), we retrospectively compared its treatment outcome against PCNL for staghorn stones at our institution.
All patients with partial and complete staghorn stones treated by FURS or PCNL between December 2014 and December 2017 were included. Outcome measures compared included duration of procedure, length of stay, retreatment rate, auxiliary rate, complications and clinical success rates(asymptomatic
Out of 22 staghorns, 10 (1 complete and 9 partials) had FURS and 12 (2 complete and 10 partials) had PCNL. Comparatively, the FURS group were older (mean 70.1 vs. 56.3 years) with higher ASA scores (median 2 vs. 1), with similar BMI (mean 29.1 vs. 26.3), maximum stone size (29.1 vs. 33.4mm), Hounsfield unit (863 vs. 875HU), Guy‘s and S.T.O.N.E. scores.
FURS was quicker to clinical success (102.4min vs. 152.7min, t-test, p>0.001), had shorter hospital stay (1.1d vs. 3.5d), higher primary procedure success (80% vs. 30%), higher 6 months success (90% vs. 54%) and similar retreatment (10%), higher auxillary treatment (100% vs. 10%). 1 patient from FURS had a small intraparenchymal aspect of staghorn inaccessible to laser. There were no complications in the FURS group. In the PCNL group, one developed a pseudoaneurysm requiring embolization, and 1 had failed PCNL access(excluded from statistical calculation).
FURS is efficacious and safe for staghorn stones treatment even in higher risk patients, and comparable to PCNL. Our initial results highlight its potential role as first-line management of staghorn stones.
Mussammet Ahmed– ST3, Worcestershire Acute Hospitals NHS Trust, Redditch, England, United Kingdom
Aniket Deshpande– Redditch, England, United Kingdom
Sidi Rashid– Redditch, England, United Kingdom
Martin Lancashire– Redditch, England, United Kingdom
Paul Rajjayabun– Redditch, England, United Kingdom
Vincent Koo– Redditch, England, United Kingdom
Worcestershire Acute Hospitals NHS Trust
Redditch, England, United Kingdom
MBBS, MRCS, PG Certificate Clinical Education
Urology Trainee (ST3) - West Midlands Deanery
Alexandra Hospital, Redditch, UK