Comparison of Safety and Effectiveness of Multi Tract Conventional and Mini Percutaneous Nephrolithotomy Simultaneously Versus Sandwich Therapy in Management of Staghorn Stones

Abstract

Objective: To compare the effectiveness and safety of multi-tract conventional and Mini PCNL simultaneously versus Sand which therapy in the management of Staghorn stones.

Study Design: A Comparative study

Place and Duration of Study: This study was conducted at the Urology Department Team "C" at the Institute of Kidney Diseases (IKD) Hayatabad Medical Complex (HMC) Peshawar from June 2020 to June 2022.

Materials and Methods: The study included a total of 80 patients with Staghorn renal stones. We had only Guys 4 score as inclusion criteria. The sample was divided into two groups by non-probability consecutive sampling. Consultants of the team performed all cases. Group-A comprised 40 patients who underwent multi-tract conventional and Mini PCNL simultaneously versus 40 patients in Group B Who had sandwich therapy (Initial PCNL followed by ESWL and then PCNL). Stone-free rates and the safety of procedures were assessed in both groups. Structured proforma was used for data collection, and then data was analyzed on SPSS 24.0

Results: In our study, complete stone clearance was recorded in 36 patients (90%) of Group-A, while it was in 30 patients (75%) in Group B. (p 0.002). Regarding safety, Group-A needed a blood transfusion in 3 patients (7.5%), while it was necessary for seven patients (17.5%) in Group B. (p 0.001) Infection-related complications were recorded in 8 (20%) patients in Group-A while 18 (45%) patients were in Group B. (p 0.002). The mean hospital stay in Group-A was 3.4±1.5 versus 12.2±3.4 days in Group B. (p 0.001). There was no mortality recorded in both group.

Conclusion: Multi-tract PCNL is more effective and safe than sandwich therapy in managing Guys 4 Staghorn renal stone. Multi tracts PCNL clears the stone more effectively as compared to sandwich therapy. Based on safety, Multi tracts PCNL had fewer infection-related complications and required fewer blood transfusions than sandwich therapy. More large-sample, prospective, multicenter, and randomized controlled trials (RCTs) should be conducted to validate our findings.