Effectiveness of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy for staghorn calculi

A recent study suggests the use of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy (aPNL) led to an increased stone-free rate (SFR) in cases of staghorn calculi, necessitated fewer percutaneous tracts, decreased the necessity for staged surgery, and resulted in a shorter operative duration compared to single percutaneous nephrolithotomy (sPNL ). The study findings were published in the journal, Urolithiasis.

A total of 160 patients were included in this prospective randomized controlled study, with 81 patients in the sPNL group and 79 patients in the aPNL group. Initially, the study focused on comparing the overall differences between sPNL and aPNL. Subsequently, the patients were categorized into two subgroups: Group 1 (patients with < 5 stone branches) and Group 2 (patients with ≥ 5 stone branches). The differences between these two subgroups were analyzed.

The study results revealed that aPNL exhibited a higher SFR and required fewer percutaneous tracts, with a shorter operation time compared to sPNL. Additionally, aPNL reduced the need for staged surgery, especially in patients with ≥ 5 stone branches. There were no significant variances in hemoglobin level changes and the requirement for blood transfusions between the sPNL and aPNL groups, and the frequency of multiple tracts was lower in the aPNL group.

Thus, it can be concluded that aPNL led to an increased SFR in staghorn calculi, necessitated fewer percutaneous tracts, minimized the requirement for staged surgery, and had a shorter operative duration compared to PNL alone. This was particularly notable in patients with ≥ 5 stone branches.