The following is a summary of “Clinical comparison of lateral supine position mini-percutaneous nephrolithotomy and anatrophic nephrolithotomy in the treatment of complete staghorn renal calculi,” published in the August 2024 issue of Urology by Chen et al.
Guidelines recommend percutaneous nephrolithotomy (PCNL) for staghorn renal calculi (SRC), but concerns exist regarding its high residual stone rates, complications, and treatment costs for complete SRC. Anatrophic nephrolithotomy (ANL) is a traditional method for SRC treatment, though its complexity limits its use in primary hospitals, leading to a preference for PCNL.
Researchers conducted a retrospective study to compare the efficacy of PCNL and ANL in treating complete SRC.
They divided 238 patients with complete SRC into 2 groups: mini-PCNL in the lateral supine position (n = 190) and ANL (n = 94) for a retrospective cohort study. They compared calculi parameters, renal function, comorbidities, complications, hospitalization duration and frequency, treatment costs, and postoperative satisfaction between the groups.
The results showed that the risk of residual stones after mini-PCNL in the lateral supine position was 239 times (OR = 238.667, P<0.0001) that of ANL, with the number of residual stones 1.3 times (OR = 1.326, P<0.0001) and the amount 2.2 times (OR = 2.224, P<0.0001) higher. Initial treatment costs were 3.3 times (OR = 3.273, P<0.0001), total costs were 4 times (OR = 4.051, P<0.0001), and hospital stays were 1.4 times (OR = 1.44, P<0.0001) higher for mini-PCNL. Postoperative renal atrophy was 2.2 times (OR = 2.171, P=0.008) more common with ANL. The Glomerular filtration rate (GFR) reduction after ANL was 1.4 times (OR = 1.381, P=0.037) greater at 24 months. Overall satisfaction was 58 times (OR = 57.857, P<0.0001) higher with ANL, and having more than 8 branches of staghorn was a high-risk factor for residual stones after mini-PCNL (OR = 353.137, P<0.0001).
Investigators concluded that ANL was generally more effective than mini-PCNL for treating complete SRC, despite a higher risk of renal atrophy and decreased GFR. ANL was preferred for SRC with more than 8 branches.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01555-z
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