Endoscopic Combined Intrarenal Surgery and Transcatheter Electrocoagulation Hemostasis in One-stage Tubeless Percutaneous Nephrolithotomy for Staghorn Stones

Abstract

Abstract Background Percutaneous nephrolithotomy (PCNL) is the primary approach employed for managing staghorn kidney stones due to their complex anatomical characteristics and extensive branching. Given the intricate nature of these stones, treatment typically necessitates multi-tract, multi-stage PCNL. This procedure carries a substantial risk of bleeding, frequently necessitating postoperative nephrostomy tubes. Consequently, patients experience increased postoperative pain and prolonged hospital stays, further contributing to discomfort. Objective The objective of this study is to evaluate the safety and efficacy of combining percutaneous nephrolithotomy with antegrade percutaneous flexible ureteroscopic lithotomy(F-URS), along with percutaneous renal access hemostasis electrocoagulation, for the one-stage tubeless PCNL management of staghorn kidney stones. Methods Five patients with staghorn kidney stones underwent PCNL in the split-leg prone position. Subsequently, the percutaneous renal channel was utilized for flexible ureteroscope to assess and extract stones from each renal calyx. After successful stone removal, the percutaneous renal tract was hemostatically coagulated using a microchannel hemostatic electrocoagulation device. Nephrostomy tubes were not retained postoperatively. On the second day after surgery, a follow-up CT scan was conducted and the Foley catheter was removed. One month later, a repeat CT scan was performed, and the double-J stent was subsequently removed. Results All patients underwent successful tubeless PCNL, with one case involving three-channel and four cases involving single-channel PCNL. Median operative time was 100 min (range: 73 min-167 min). None of the patients experienced bleeding, fever, back pain, or other symptoms. Postoperative CT scans revealed no residual stones or perirenal leakage. All patients were discharged two days after the surgery. One month later, a follow-up CT scan was conducted, demonstrating no perirenal effusion. Conclusion The combination of PCNL with antegrade percutaneous F-URS, along with percutaneous renal access hemostasis electrocoagulation, offers a one-stage tubeless PCNL treatment approach for staghorn kidney stones. This approach has shown potential in enhancing the success rate of tubeless PCNL, decreasing the need for multiple percutaneous renal tracts, effectively reducing both hospital stays and postoperative pain, and improving the stone-free rate. Overall, it represents a safe and effective method. Nevertheless, due to the limited number of cases, further research is required to investigate its clinical efficacy.