Material and Methods:
This is a retrospective analysis of patients who underwent PCNL for staghorn renal stones at the Ministry of Health Izmir Bozyaka Training and Research Hospital between April 2011 and January 2017. All the data of the patients were obtained from their electronic medical records. Patients with a history of neuromuscular disease, congenital kidney anomalies, coagulopathy, skeletal deformity, and solitary kidneys, cases requiring multiple accesses, and patients without staghorn stones were excluded from the study. A total of 182 staghorn stones were divided into two groups according to patient age: those aged <65 years old were defined as Group-1 and those aged ≥65 years as Group-2. The demographic, perioperative and postoperative data were compared between these two groups.
All the patients were evaluated preoperatively using standard non-contrast abdominal computed tomography (CT). The patients’ demographic characteristics such as gender and body mass index, and preoperative characteristics, including operation side and history, stone burden, metabolic syndrome (presence of at least two of the following diseases: diabetes mellitus, hypertension, hyperlipidemia and/or obesity), and stone density were recorded. In addition, intraoperative and postoperative results (operation time, fluoroscopy time, nephroscopy time, length of hospital stay, calyx accessed, complications, and stone-free status) were examined. Postoperative complications were evaluated according to the Clavien scoring system (8) and divided into two groups as minor (grades I and II) and major (grades III to V).
After the urine culture of the patients was confirmed to be negative, they were taken to the operation room. Ceftriaxone was administered to the patients as prophylaxis before the operation and continued until the nephrostomy tube was removed. No nephrotoxic drug was used in any of the patients before, during or after the operation.
Stone burden was calculated in square millimeters in all patients (length x width x π x 0.25, where 3.14 was taken as the mathematical constant) (9). For staghorn stones, this calculation was performed separately for each calyceal stone and the sum of all values was accepted as the result. All PCNL operations were performed by experienced urologists. Success was considered as complete stone-free status or detection of <4 mm stones on control CT performed at the first postoperative month.