Comparison of Outcomes After Percutaneous Nephrolithotomy of Staghorn Calculi in Those with Single and Multiple Accesses

PURPOSE: To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi. PATIENTS AND METHODS: The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed. RESULTS: The mean number of percutaneous accesses was 2.42 +/- 0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P = 0.002, P < 0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P = 0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P < 0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03 mg/dL and 1.08 mg/dL in group 1, and 0.9 mg/dL and 1.03 mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P = 0.16). CONCLUSIONS: The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi.