Abstract：Objective:To report our experience of retrograde intrarenal surgery (RIRS) with flexible ureteroscope as the effective supplementary treatment modality for residual stones following percutaneous nephrolithotomy (PCNL) for staghorn calculi in solitary kidney. Methods:35 patients with staghorn calculi, burden (1 210.6±78.1)mm2 in solitary kidney received staging treatment that PCNL followed by RIRS for residual stones.Operative findings and complications were documented and analyzed. Results:The mean operative time was (75.4±19.2) minutes for the first stage PCNL, and (63.5±17.4) minutes for second stage RIRS, respectively.Hemoglobin drop after PCNL was (28±10)g/L and (12±6) g/L after RIRS, respectively.Blood transfusion was noted in 3 patients (8.6%), and one patient (2.9%) received selective renal arterial embolization for severe hemorrhage following PCNL, no other severe complication was noted.Final stone free rate was 85.7%. Conclusions:With staging procedures that debulking most partition of staghorn calculi in the first stage PCNL, followed by RIRS with flexible ureteroscope as the supplementary treatment modality for residual stones in second stage, which can get a high SFR and reduce the need for multiple tracts, thereby reducing blood loss and potential morbidity.
[1]Zhong W, Zeng G,Wu W, et al. Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res, 2011, 39(2):117-122. [2]El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Post percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol,2007,177(2):576-579. [3]Turna B, Nazli O, Demiryoguran S, et al. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology, 2007, 69(4):603-607. [4]Bucuras V, Gopalakrishnam G, Wolf JS Jr, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: nephrolithotomy in 189 patients with solitary kidneys. J Endourol, 2012, 26(4):336-341. [5]Marguet CG, Springhart WP, Tan YH, et al. Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int, 2005, 96(7):1097-1100. [6]Xu G, Li X, He Y, et al. Staged single-tract minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney. Urol Res, 2012, 40(6):745-749. [7]Zhong W, Zeng G, Wu K, et al. Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever? J Endourol, 2008, 22(9): 2147-2151.
