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A prospective randomized trial of open surgery versus endourological stone removal in patients of staghorn stones with chronic renal failure

Author(s): Kumar Anant | Verma Balbir | Gogoi Sanjay | Kapoor Rakesh | Srivastava Aneesh | Mandhani Anil

Journal: Indian Journal of Urology
ISSN 0970-1591

Volume: 18;
Issue: 1;
Start page: 14;
Date: 2001;
Original page

Keywords: Chronic Renal Failure; Staghorn Calculi.

Introduction: Renal stones with chronic renal failure (CRF) is a complex problem due to various inherent problems associated with CRP. Treating these stones is a challenge and therapy has to be tailored accordingly. Although there are many studies in the literature regarding the optimum management of staghorn stones with Percutaneous Nephrolithotomy (PCNL) alone or in combination with Extracorporeal Shock Wave Lithotripsy (ESWL); but the issue of staghorn stones with associated CRF has not been addressed adequately till date. Current study compares the role of open surgery vs PCNL in staghorn renal stones with CRF. Material and Methods: 26 patients with staghorn renal calculi and CRF were randomized to open (group I) and PCNL (group II) groups. The pre and postoperative hemoglobin (HB), hematocrit (HCT), serum creatinine and urine culture, size of stones, intraoperative blood loss, number of transfusions, surgical complications and duration of procedure was documented. Hemodialysis was done as and when necessary. The residual stone in both groups were treated with ESWL. Hospital stay and overall cost of treatment were analyzed. Results: A total of 10 patients were randomized to group I and 16 patients to group II (18 males and females). The two groups were comparable in terms of age (43.1 ± 13.9 vs 53.0 ± 15.5 yrs), preoperative serum creatinine (380.1 ± 247.5 vs 327.1 ± 88.4 pmol/L), Hb (88.0 ± 24.0 vs 95.0 ± 24.0 gm/L) and HCT (28.9 ± 7.9% vs 30.4 ± 7.3%). Stone size was 1713 ± 1470.2 and 1675 ± 2737.5 mm2 in group I and group 11 respectively. Preoperative culture was positive in 70% of open and 30% of PCNL group. The operating time (1160 ± 44.0 vs 152.5 ± 53 mins), and complication rate (10%in each) were similar in group 1 and group II respectively. Intraoperative blood loss was more in group II but it did not reach statistical significance. 1 patient in group I and 4 in group II required blood transfusion. The average number of sittings required in PCNL was 1.7 ± 0.67 with a puncture rate of 1.9 ± 0.73 per patient. Postoperative Hb, HCT, serum creatinine, bleeding, collections and fever were comparable in the two groups. Overall stone clearance (after adjuvant ESWL) was better in open (80%) as compared to PCNL (62.5%) group. The overall cost of treatment was significantly lower in open (Rs. 8333.3 ± 2851.3) as compared to PCNL (Rs. 16940 ± 4171.9). Hospital stay in the two groups was comparable (12.6 ± 6.1 and 12.9 ± 4.1 days in open and PCNL respectively). Conclusion: In view of the better clearance rate and lesser cost of treatment, open surgery still has a place in the management of staghorn stones with chronic renal failure even in a tertiary urological center. However postoperative pain and a larger scar cannot be ignored.

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