Comparison of mini-percutaneous vs. Standard nephrolithotomy for staghorn stones
Keywords:Staghorn stones, percutaneous nephrolithotomy, stone-free rate, surgery, hospital stay, complications, postoperative pain
Background: The treatment for staghorn stones is known as mini-percutaneous nephrolithotomy (mini-PNL), which is a minimally invasive surgical procedure. Despite its shorter duration, reduced morbidity, and lower blood loss when compared to standard nephrolithotomy, it may offer similar results. This study aims to compare the safety and efficacy of mini-PNL versus conventional nephrolithotomy for the treatment of staghorn stones.
Objectives: To evaluate the clinical effectiveness (stone-free rate and complication rate) and safety (time to stone clearance, perioperative and postoperative morbidity, hospital stay, and blood loss) of mini-percutaneous nephrolithotomy (PNL) in comparison to standard nephrolithotomy for the management of staghorn stones.
Study design: A randomized controlled trial
Duration and place of study: Department of Urology, Sahiwal Teaching Hospital, Sahiwal, from January 2021 to August 2021
Methodology: To determine the stone-free rate among patients with staghorn stones, we conducted a randomized controlled trial at the Department of Urology, Sahiwal Teaching Hospital, Sahiwal, from January 2021 to August 2021. The study spanned a total of two years. Seventy-five patients participated in the study and were divided into two groups for standard PCNL and mini-PCNL procedures. Patients were randomly assigned to one of these procedures, with 50% undergoing regular PCNL and the remaining 50% receiving mini-PCNL. Throughout the trial, we collected data on hospital stay durations, complications, and pain levels.
Result: This study comprised 75 patients with a mean age of 53.02 years (range 20-90 years). Men comprised 86% of the participants,
while women comprised 16%. Success rates for the mini-PCNL and normal PCNL were 91.2% and 96.8% (p=0.05). Additionally, the miniPCNL group had a significantly lower mean operation time (81.1 minutes) and a shorter mean hospital stay (3.3 days) ((p-0.001)) than the standard-PCNL group (104.2 minutes and 03.3 days, respectively). The complication rate for standard PCNL was more significant than for mini-PCNL (25% vs. 13%, p = 0.036). Further, there was significantly decreased postoperative pain in the mini-PCNL group (p-0.001).
Conclusion: Mini-PCNL proves to be an efficient and safe treatment option for staghorn stones, offering numerous advantages over the traditional Standard-PCNL method. It excels in minimizing postoperative pain, shortening hospital stays, and reducing operating room time when compared to standard PCNL. Consequently, mini-PCNL is emerging as the preferred approach for effectively managing staghorn stones.
Keywords: Staghorn stones, percutaneous nephrolithotomy, stone-free rate, surgery, hospital stay, complications, postoperative pain