Modalities of Management of Residual Upper Calyceal Stones Post PCNL for Staghorn Stone

Background This study aimed to investigate management strategies for residual upper calyceal stones measuring 1-2 cm following a standard percutaneous nephrolithotomy for staghorn calculi, with a focus on assessing the safety and efficacy of conservative management as a possible option compared to the intervention. Methods This randomized trial included 105 patients with residual upper calyceal stones (1-2 cm) after-percutaneous nephrolithotomy. Patients were assigned to three groups: flexible ureterorenoscopic laser lithotripsy (Group A), extracorporeal shock wave lithotripsy (ESWL, Group B), and conservative management (Group C). The study evaluated need for subsequent interventions in the conservative group (C), stone-free rates, postoperative complications, and cost-effectiveness. Patients were followed up for up to one year to assess outcomes including pain, hematuria, hospital readmission, and stone clearance. Results Conservative management led to a 20% rate of intervention within the first year due to complications, such as pain (4 patients), obstruction (2 patients), or patient request (1 patient). A stone size threshold of ≤ 1.4 cm was a strong predictor for intervention. In contrast, surgical intervention had better outcomes. Flexible ureterorenoscopic laser lithotripsy achieved a 94.29% stone-free rate, while extracorporeal shock wave lithotripsy achieved 71.43% (p = 0.023). Although extracorporeal shock wave lithotripsy was more cost-effective (10.17x10³ Egyptian pounds vs. 39.47x10³ Egyptian pounds, p < 0.001), it was less effective for higher- density stones Conclusions While conservative management may appear less invasive initially, our study revealed that it resulted in a greater need for subsequent interventions and a higher incidence of long-term morbidity compared to early intervention with either flexible ureteroscopy or extracorporeal shock wave lithotripsy.