Preliminary Outcome Comparison of Flexible Uretero-Renoscopic Lasertripsy versus PCNL in the Treatment of Staghorn Calculi

Main Article Content

Vincent Koo
Mussammet Ahmed
Aniket Deshpande
Ahmed Kodera

Abstract

Percutaneous nephrolithotomy (PCNL) is a well-established treatment for staghorn stones. Given the im-provement in technology and techniques of flexible ureterorenoscopic lasertripsy (FURS), we retrospectively compared its treatment outcome against PCNL for staghorn stones at our institution.


Materials and Methods
All patients with partial and complete staghorn stones treated by FURS or PCNL between December 2014 and December 2017 were included. Outcome measures included the duration of the procedure, length of stay, retreatment rate, auxiliary rate, complications, and clinical success rates (stone or dust-free status). Results
Out of 22 staghorns, 10 (1 complete, 9 partial) had FURS and 12 (2 complete and 10 partial) had PCNL. Comparatively, the FURS group were older (mean 70.1 vs. 57.1 years, U-test p<0.001) with higher mean ASA scores (mean 2.3 vs. 1.5, U-test, p=0.04), with a similar body-mass index (mean 29.1 vs. 27.3), maximum stone size (29.7 vs. 34.6mm) and Hounsfield unit (836 vs. 891HU).



FURS was quicker to clinical success (102.4min vs. 159.5min, U-test p<0.001) and had shorter hospital stay (1.1d vs. 3.5d, U-test p<0.001). Higher primary procedure success [80% vs. 36%, 95% CI = (-3.0%, 74.5%)], higher overall success [90% vs. 73%, 95% CI = (-22%, 51%)], similar retreatment rate (10%), and higher auxiliary treatment rate (100% vs. 18%) were observed. 1 patient from FURS had a small intrapa-renchymal aspect of staghorn inaccessible to a laser. There were no complications in the FURS group. In the PCNL group, one developed a pseudoaneurysm requiring embolization, and 1 had failed PCNL access (excluded from the statistical calculation).


Conclusion
Our preliminary data suggest that FURS is efficacious and safe for staghorn stones treatment, and comparable to PCNL. In this context, we highlight FURS potential role as first-line management of staghorn stones.

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How to Cite
Koo, V., Ahmed, M., Deshpande, A., & Kodera, A. (2020). Preliminary Outcome Comparison of Flexible Uretero-Renoscopic Lasertripsy versus PCNL in the Treatment of Staghorn Calculi. Journal of Endoluminal Endourology, 3(2), e31-e36. https://doi.org/10.22374/jeleu.v3i2.89
Section
Original Article
Author Biographies

Vincent Koo, Alexandra Hospital, Worcestershire Acute Hospitals NHS Trust

Department of Urology 

Mussammet Ahmed, Alexandra Hospital, Worcestershire Acute Hospitals NHS Trust

Department of Urology 

Aniket Deshpande, Alexandra Hospital, Worcestershire Acute Hospitals NHS Trust

Department of Urology 

Ahmed Kodera, Alexandra Hospital, Worcestershire Acute Hospitals NHS Trust

Department of Urology 

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