Category: Clinical Stones: Outcomes

MP13-18 - Outcome efficacy of Flexible Ureterorenoscopic Lasertripsy versus Percutaneous Nephrolithotomy in the treatment of staghorn stones

Fri, Sep 21
2:00 PM - 4:00 PM

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.

Methods :

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

Results :

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).

Conclusions :

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

Worcestershire Acute Hospitals NHS Trust
Redditch, England, United Kingdom

Mussammet Ahmed
MBBS, MRCS, PG Certificate Clinical Education
Urology Trainee (ST3) - West Midlands Deanery
Alexandra Hospital, Redditch, UK

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