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Background: Percutaneous nephrolithotomy (PCNL) for large stone burden can be problematic in patients with significant risk of bleeding complications, specifically thrombocytopenia. This report demonstrates effective correction of two patients' thrombocytopenia, subsequently leading to removal of large stone burden through PCNL. Case Presentation: We present two Middle Eastern patients who presented with medical histories significant for thrombocytopenia, secondary to splenomegaly and hepatic vein thrombosis, and large volume nephrolithiasis. Patient 1 is a 65-year-old female with a right 5 cm stone and a platelet count of 34,000. Patient 2 is a 45-year-old female with a 3 cm left staghorn stone and a platelet count of 44,000. After consultation with hematology, both underwent therapy with prednisone and intravenous immunoglobulin without improvement in their platelet count. They then received 3 μg/kg/dose of romiplostim weekly that improved their platelet counts to 133,000 and 195,000 in 2 weeks, respectively. Patient 1's PCNL was completed in a single-stage procedure with stone-free status shown on CT postoperative day 1. Patient 2 underwent PCNL and a secondary ureteroscopy for residual stone fragments on postoperative day 2. Both patients experienced no complication during the procedure, hospital stay, or postoperative course. Both continued romiplostim for 20 days postoperatively with platelet levels returning to their baseline range after 1 month. Conclusion: In the appropriately selected patient, romiplostim can correct thrombocytopenia enough to safely and effectively perform PCNL in patients with underlying hematologic disorders. Close coordination between urology and hematology is imperative to ensure an effective outcome in this challenging patient population.

Staghorn stone volume and its distribution within the collecting system, "staghorn morphometry," predicts the requirement of tract and stage for percutaneous nephrolithotomy (PCNL) monotherapy. The purpose of the study was to develop a CT urography staghorn morphometry-based prediction algorithm to predict tract(s) and stage(s) for PCNL monotherapy and classify staghorn accordingly.A retrospective case-control design of 94 units was used. CT software calculated the total stone volume (TSV) with absolute volume and percentile volume in the pelvis, planned entry calix, favorable and unfavorable calix. Entry calix was the optimum calix chosen, keeping the relations of the ribs and adjoining viscera that could clear maximum stone volume. Unfavorable calix was defined as having an acute angle from the entry calix and infundibular width of ≤ 8 mm. A prediction model with odds ratio (OR) (95% confidence interval) was constructed on univariate and multivariate regression factors.On univariate analysis, TSV (P=0.013), unfavorable calix stone volume (0.007), and percentile distribution of stone in pelvis (0.026), pelvis and entry calix (0.001), and unfavorable calix (0.001) predicted tracts while total stone (0.001), pelvic stone (0.0046), and unfavorable calix stone (0.001) volume and percentile volume in pelvis (0.04), pelvis and entry calix (0.005) and unfavorable calix (P0.001) predicted stage. Multivariate analysis showed that unfavorable calix stone percentile volume predicted tract (area under the curve [AUC] - 0.91) while TSV and unfavorable calix stone percentile volume (AUC - 0.846) predicted stage. The OR-based prediction model suggested a need for single tract and stage PCNL vs multiple tract and stage PCNL for TSV and unfavorable calix percentile stone volume of (5,000 mm(3) and 5%) and (20,000 mm(3) and 10%), respectively.The model predicts the tract and stage for PCNL monotherapy. Staghorn morphometry differentiates staghorn into type 1 (single tract and stage); type 2 (single tract-single/multiple stage, or multiple tract-single stage), and type 3 (multiple tract and stage).

Introduction and Objectives: Crossed fused ectopia is a rare congenital renal anomaly that can be associated with concomitant ureteropelvic junction obstruction, malrotation, and abnormal ...

Complex staghorn calculi have conventionally been treated with percutaneous nephrolithotomy, extracorporeal lithotripsy, or, occasionally, open surgery. Access to branched calculi is difficult through a single percutaneous track. We tested and make a case for a synchronous bidirectional technique combining the use of flexible instruments through percutaneous and retrograde approaches. We present a case of "pass the ball," which may have a place in tackling large, complex, or branched staghorn calculi without the need for multiple percutaneous punctures, removing larger fragments than is possible through the ureter and avoiding multiple passes through the ureter, saving time and decreasing the possibility of iatrogenic ureteral injury.

Although the supracostal approach is thought to increase the difficulties and patient morbidity of PCNL, it facilitates the management of certain urinary infirmities, such as UPJ obstruction, staghorn stone, upper pole stone, proximal ureteral abnormalities, impacted UPJ stone and upper calix diverticulum. Hereby the authors briefly comment on the technical aspects of the supracostal approach, and also discuss the possible complications of this technique and how to avoid them.

Purpose: To investigate the safety and efficacy of high-power holmium laser (70 W) in percutaneous nephrolithotripsy (PCNL) for large staghorn calculi. Materials and Methods: From December...

WOS: 000293514200007, PubMed ID: 21774666, Purpose: The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. Patients and Methods: Data over a 1-year period from consecutively treated patients from 96 centers worldwide were collated. The following variables in patients with staghorn or nonstaghorn stones were compared: National prevalence, patient characteristics, access method, puncture frequency and outcomes, including bleeding rates, operative time, and duration of hospital stay. Results: Data from 5335 eligible patients were collated; 1466 (27.5%) with staghorn and 3869 (72.5%) with nonstaghorn stones. Staghorn stone presentation varied between centers from 67% in Thailand to 13% in Argentina. The frequencies of previous procedures were similar between groups, but shockwave lithotripsy was less frequent in patients with staghorn stones compared with nonstaghorn (16.8% vs 22.6%) and positive preoperative urine cultures were more frequent in patients with staghorn than nonstaghorn stones (23.4% vs 13.1%). Patients with staghorn stones underwent multiple punctures more frequently than those with nonstaghorn stones (16.9% vs 5.0%). Postoperative fever, bleeding, and the need for blood transfusion were more frequent, the median operative time and duration of hospital stay were longer, while the proportion of patients remaining stone free was lower (56.9% vs 82.5%) in patients with staghorn than nonstaghorn stones. Conclusions: The proportion of patients with staghorn stones varies widely between centers. Stone-free rates were lower, complications more frequent, and operative time and hospital stay were longer in patients with staghorn stones., Global CROES PNCL study, The Global CROES PNCL study was supported by an unrestricted educational grant from Olympus.

Despite the advent of extracorporeal shock wave lithotripsy, percutaneous nephrolithotripsy still plays a prominent role in the management of large and staghorn renal calculi. Modalities available for intracorporeal lithotripsy include ultrasound, electrohydraulic, and laser. I report my experience with the Swiss Lithoclast in performing percutaneous nephrolithotripsy in 45 patients. The advantages of this device in percutaneous stone removal include its rapidity, safety, ease of use, and usefulness in clearing the initial calix during staghorn stone removal.

The results of 117 consecutive staghorn stones treated with extracorporeal shock wave lithotripsy (SWL) monotherapy between March 1985 and October 1988 were reviewed. At 8 months after the initial ...

To date, the percutaneous approach to the removal of calculi in true pelvic kidneys has been applied to three patients at our institution as an alternative to open surgery. Access to the pelvic kidney is effected by means of retrograde percutaneous nephrostomy in conjunction with the laparoscopic manipulation and displacement of interposing bowel loops. Two patients were rendered free of stones with less than 1 week of hospitalization. The other patient had a staghorn stone that proved too large for removal without multiple nephrostomy tracts, and open pyelolithotomy was performed.