Single-stage percutaneous nephrolithotomy combined with flexible ureteroscopy for the management of staghorn calculi with pyonephrosis / 中华泌尿外科杂志

ABSTRACT

Objective:To evaluate the feasibility, safety and efficacy of single-stage percutaneous nephrolithotomy (PCNL) combined with flexible ureteroscopy (FURS) for the management of staghorn calculi with pyonephrosis.Methods:A total of 13 patients of staghorn renal calculi with pyonephrosis, which was diagnosed by intraoperative pelvic urine bacteria culture, were treated by PCNL combined with FURS from May 2017 to December 2019. Of all the 13 patients, 7 were males and 6 were females, with mean age of 52.5 years, ranged from 33 years to 68 years. The mean stone burden was (1 070.9±397.0) mm 2, ranged from 507.4 mm 2 to 1 809.5 mm 2. Bacteria culture and microbial sensitivity test was performed for all the patients. Four patients with fever on admission accepted ureteral stenting at least a week before the surgeries. All the patients received preoperative antibiotic therapies for at least a week, and the infective symptoms and inflammatory indexes was normal before the surgeries. Under general anesthesia, the procedures were performed in a modified supine Valdivia position. After the transurethral FURS was performed, the standard percutaneous track was placed at the subcostal point between mid-axillary line and scapular line under the FURS and ultrasounic guide. The purulence and the stones were shattered and removed by PCNL with negative pressure system, and FURS helped to shatter and move out the stones beyond the PCNL reach through the same tract. A double-J tubes and a nephrostomy tube was routinely indwelled postoperatively. A radiological imaging was performed within three days after the operation to evaluate the stone free rate. The residual stone was defined as the stone larger than 4 mm. Results:All the procedures were successful. The one-stage stone free rate was 76.9% (10/13). The mean operation time was (94.2±21.8) min, ranged from 65 to 135 min. Six patients suffered postoperative systemic inflammatory response syndrome, and no patient occurred sepsis or complications of Clavien-Dindo classification Ⅲ or above. They were followed up for 3-24 months with median of 12 months.Four cases with recurrence of ipsilateral stones, two cases with ipsilateral mild renal atrophy, no recurrent ipsilateral upper uninary infection were found in the followup.Conclusions:Single-stage PCNL combined with flexible ureteroscopy could be feasible for the management of staghorn calculi with pyonephrosis with safety and efficacy.