Combined Minimally Invasive Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Staghorn Calculi in Patients with Solitary Kidney

Background: To present our experience with simultaneous combined minimally invasive percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS) to manage patients with staghorn calculi in solitary kidney, and evaluate the safety, efficiency and feasibility of this approach. Methodology/Principal Findings: The study included 20 patients with staghorn calculi in solitary kidney. Demographic characteristics, stone location and surface area were recorded. After informed consent, the patients underwent one stage MPCNL firstly. Combined second stage MPCNL and RIRS simultaneously were performed at postoperative 5-7 days. Operative parameters, stone-free rate (SFR), stone analyses and complications were evaluated. Serum creatinine (Scr), glomerular filtration rate (GFR) and chronic kidney disease (CKD) were measured preoperatively, postoperatively at 1 month, and each follow-up visit. All patients had staghorn stones involving multiple calyces. The mean stone burden was 1099.9 +/- 843.95 mm(2). All patients had only one percutaneous access tract. The mean whole operative duration was 154.37 +/- 32.45 min. The mean blood loss was 64 (12-140) ml. The final SFR was 90%. During the 1-month follow-up study period, four patients improved in CKD stage. Two patients who had CKD (stage 5) still needed dialysis postoperatively. Mean Scr of the rest patients preoperatively was 187.16 +/- 94.12 compared to 140.99 +/- 57.92 umol/L by the end of 1-month follow-up period (p = 0.019). The same findings were observed in GFR in that preoperatively it was 43.80 +/- 24.74 ml/min and by the end of the 1-month follow-up it was 49.55 +/- 21.18 ml/min (p = 0.05). Conclusions/Significance: Combined MPCNL and RIRS management effectively decrease the number and size of percutaneous access tracts, which is safe, feasible, and efficient for managing staghorn calculi in solitary kidney with satisfactory SFR and reducing blood loss, potential morbidity associated with multiple tracts. The approach did not adversely affect renal function at both short-term and long-term follow-up.