| Abstrakt: |
Objective: To compare the clinical outcomes of ultrasound-guided percutaneous nephrolithotomy (US-PCNL) in lateral position and anatrophic nephrolithotomy (ANL) in the treatment of staghorn renal stones. Methods: Between October 2016 and July 2020, individuals with staghorn renal stones undergoing an operation at Buri Ram Hospital in Thailand were included in this study. They were divided between group I (patients undergoing US-PCNL, n=114) and group II (patients undergoing ANL, n=112). The outcomes regarding stone-free rate (residual stone less than 4mm with asymptomatic), the stone clearance rate (the elimination rate of total stone surface after the operation), operative times, length of hospitalization, and complications were collected and analyzed. Results: The patient's demographics and stone characteristics were not significantly different between the two groups, except that more preoperative hydronephrosis was found in the ANL group (78.6% vs. 53.5%, p<0.001). Regarding the primary outcome, the stone-free rate was significantly lower in the US-PCNL group (47.4% vs. 75.9%, p<0.001), whereas the stone clearance rate was not significantly different (96.4±6.0% in the US-PCNL group and 97.7±5.8% in the ANL group, p=0.098). No difference was found according to the major and minor complications between the US-PCNL and ANL groups; however, the US-PCNL group had a significantly lower transfusion rate than the ANL group (3.5% vs. 17.9%, p<0.001). The total operative time in both groups was not different; however, the length of hospitalization for the US-PCNL was significantly shorter than for the ANL group (10.0 vs. 12.9 days, p=0.002). A multivariate analysis revealed that the operative method was a significant factor associated with the stone-free rate (OR=5.96, 95%CI=3.06-11.62, p<0.001), blood transfusion (OR=5.75, 95%CI=1.84-18.03, p=0.003), and the length of hospitalization (F=10.27, p=0.002); while the percentage of stone clearance were not statistically different between the two operation methods (F=2.76, p=0.098). Conclusion: The ANL had a higher stone-free rate for patients with staghorn stones; however, the stone clearance rate was not significantly different between the US-PCNL and ANL groups. The advantages of the US-PCNL over the ANL were less blood transfusion and shorter length of hospitalization, while the complications were not significantly different between the two operative methods. [ABSTRACT FROM AUTHOR] |
