Background: The use of minimally invasive techniques in the treatment of staghorn and multiple renal stones has overshadowed the open techniques in the past two to three decades. In this study, we reevaluate the role of open techniques in the management of these conditions.
Objective: To compare the role of open techniques versus combined percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in the management of staghorn and multiple renal stones.
Methods: Between 1999 and early 2005, a total of 208 patients were operated upon: 111 patients with 118 renal units underwent open-technique surgery, and 97 patients with 106 renal units underwent combined PCNL and ESWL. Operative time, operative cost, blood loss, stone-free rate, use of single or multiple sessions, hospital stay, complications, total cost, and time to return to ordinary activities were calculated and plotted in a database, analyzed, and compared for the two groups of patients.
Results: Operative time for the open group was significantly less than the PCNL group, as most of the latter needed multiple sessions of PCNL and ESWL, raising the hospital stay, the operative cost, and the total hospital cost. In the open group, 106 (89.8%) patients were stone free in a single session, and only 12 (10.2%) needed ESWL sessions. In the PCNL group, 88 (83%) patients were stone free after the first session, a statistically significant difference. However, the time needed for convalescence was significantly less for the PCNL group.
Comparing the complication rate for both groups, we found that the open group had less incidence of colonic injury, AV fistula, and urinary leakage, which reflected on the length of hospital stay and cost. However, the open group had more incidence of blood loss and pneumothorax, comparable incidence of sepsis, and needed more time to return to ordinary activity compared to the PCNL group.
Conclusion: Open techniques are still a viable option that should be considered when treating patients with complex multiple and staghorn renal stones, especially regarding their cost-effectiveness in the face of limited resources in developing countries.
Keywords: Stone, Renal, Staghorn, PCNL, Open
Correspondence: Mohamed Ali A Ismail, Urology Department, Theodore Bilharz Research Institute, Giza, Egypt,