Comparison of 1-stage With 2-stage Multiple-tracts Mini-percutaneous Nephrolithotomy for the Treatment of Staghorn Stones: A Matched Cohorts Analysis

ObjectiveTo identify the better of 2 treatment strategies, single stage vs 2 stages, and to create multiple tracts in mini-percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stone.Materials and MethodsRecords of patients who underwent MPCNL with multiple tracts for the treatment of staghorn stones from 2011 to 2013 were retrospectively reviewed. Two-stage (as group 1) and 1-stage strategies (as group 2) to establish the multiple tracts were performed. A total of 145 pairs were matched for the analysis according to age, preoperative hemoglobin, preoperative urine culture, stone surface area, and stone size.ResultsIn group 2, 45.5% of success rate of patients were achieved after a single procedure with a mean of 2.63 ± 0.62 tracts. The remaining patients required a second procedure, necessitating the placement of multiple tracts or the reuse of the existing tracts. The final success rate was similar in both group 1 and group 2 (82.1% vs 84.2%; P = .638). There was a significant decrease in the mean number of total access tracts, infection complications, and blood transfusion rate in group 1 than in group 2. The infection and bleeding complications were similar for both groups during the subsequent treatment.ConclusionThe 2-stage MPCNL treatment plan for staghorn stones was more advantageous for 2 reasons: (1) Almost half of the patients who were treated using a 1-stage treatment plan required subsequent procedure to achieve a satisfactory success rate; (2) An initial treatment plan using the 2-stage approach resulted in less complication and less tracts established.