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Objective: To analyze the outcomes of single-session bilateral PCNL in a horseshoe kidney patient with bilateral staghorn stones in terms of safety and effectiveness. Case(s) Presentation: A 64-year-old woman with bilateral staghorn stones on HSK. She had an anesthesia status of ASA 2, with type 2 diabetes mellitus (uncontrolled with oral medication), 47% of ejection fraction from echocardiography and her body mass index was 21.7 kg/m2. A single session of bilateral PCNL was performed, with 150 minutes of surgery and total blood loss of ± 50 cc. A 4.7 Fr DJ stent was placed on the right kidney, a 5 Fr ureteral catheter was left in the left kidney, and a 16 Fr foley catheter was placed as a right and left nephrostomy. Control plain abdominal x-ray showed no residual stones. Postoperatively, the patient was hospitalized for 3 days, there were no significant complaints and discharged in good condition. Discussion: The procedure was performed in the prone position for two reasons. First, is to avoid intestinal injury during puncture and dilatation, the second is to simplify the positioning of the C arm, as well as the endourology monitor, and the other instruments. Conclusion: Single-session bilateral PCNL for HSK patients with bilateral staghorn stones, in our experience, is quite safe and effective. Keywords: Horseshoe kidney, single-session bilateral percutaneous nephrolithotomy (PCNL), staghorn stone.

Squamous cell carcinoma of the renal pelvis is a rare neoplasm. The incidence does not exceed 1% of all neoplasms of this localization. In the general population, up to 90% of all neoplasms of the renal pelvis are represented by urothelial carcinoma, while from 0.7% to 7.0% of cases are squamous cell carcinoma. Stones of the renal collecting system are found in 14 – 50% of patients with squamous cell carcinoma of the pelvis. As a possible etiopathogenetic mechanism, chronic inflammation on the background of a stone is considered, leading to squamous urothelial metaplasia with subsequent keratinization and malignization. Clinical manifestation of squamous cell carcinoma of the renal pelvis is nonspecific and is primarily associated with manifestations of urolithiasis. Squamous cell carcinoma of the renal pelvis is characterised by high aggressiveness, insensitivity to chemotherapy and radiation therapy, and consequently an unfavourable prognosis. The survival rate of most patients is less than one year from the diagnosis, while the 5-year survival rate does not exceed 10%. We present our own clinical case of a patient with a staghorn stone and squamous cell carcinoma of the renal pelvis.

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn stones. However, residual stones in calyces remain a challenge due to the limited angle which makes the approach difficult. The new operative technique of endoscopic combined intrarenal surgery (ECIRS), which integrates the advantages of PCNL and retrograde intrarenal surgery (RIRS), was developed to overcome this difficulty. However, two experienced urologists are required to perform ECIRS, and the patient has to be placed in the Galdakao-modified supine Valdivia position or modified prone split-leg position which cannot be achieved in the elderly or patients with ankylosing arthritis, as it may cause harm due to abnormal traction of the joints. In addition, it is difficult for surgeons to create an ideal access tract to perform PCNL in this position. We report the case of a 72-year-old female patient with left staghorn stone. We performed RIRS first and then placed the patient in the decubitus position for PCNL with antegrade flexible ureteroscopy. This method allows patients to be placed in an easier position, with the use of flexible ureteroscopy through a nephroscope to find previously unreachable stones. Moreover, in addition to the more comfortable position both for surgeons and patients, this procedure can also deal with large complex renal stones as with ECIRS. We also created a brand-new definition for stone clearance rate, namely, stone reduction efficiency (SRE). There was a high stone reduction efficiency of 12.64 (mm2/min) in our patient, and no complications occurred. We suggest that this procedure is an ideal alternative treatment for a huge staghorn stone instead of PCNL or ECIRS. [ABSTRACT FROM AUTHOR]

We here report a rare case of congenital megapolycalicosis in a 14-year-old girl complicated by a 24-mm staghorn stone and numerous calculi at the level of all caliceal groups that had become symptomatic in recent weeks with malaise, hematuria, and urinary tract infection. Among the various therapeutic options, we opted for open surgery. The staghorn stone was removed by pyelotomy, and washout of the caliceal cavities released numerous microcalculi of 1.5−9 mm in size that were then removed. To our knowledge, this is the first case of pediatric megacapolycalicosis complicated by staghorn stone, which presents complex problems for the diagnosis and therapy.

Purpose: To compare the performance and outcomes of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) in the management of staghorn kidney stones.Materials and Methods: This study was a parallel-group randomized clinical trial study carried out on 68 patients with staghorn stones (one single piece or maximally two-piece stones with large extra renal part) over 18 years referred to Labbafinejhad Hospital. Patients were randomly divided on a ratio of 1:1 into two groups of LPL and PCNL using random allocation software. The primary outcome was the stone free rate, which was evaluated with KUB, and ultrasonography. Secondary outcomes were duration of surgery, bleeding, fever, post-operative pain, length of hospital stay, and postoperative complications.Results: The mean±SD age of patients in PCNL and LPL groups were 48.50 ± 13.33 years and 52.17 ± 15.74 years, respectively (P=.303). LPL was associated with a higher duration of surgery (196.55 ± 26.58 minutes versus 110.88 ± 34.82; P=.001). Hemoglobin drop in the PCNL group was higher than the LPL group (2.67 ± 2.61 g/dL versus -0.7912 ± 1.06 g/dL; P=.001). Stone free status was observed in 29 (85.3%) patients in the LPL group, which was significantly higher than the PCNL group (22 patients, 64.7%; P =.050).Conclusion: The results of this study indicate that LPL offers a higher stone free rate with less bleeding in patients with single particle or limited particles staghorn stones with extrarenal pelvis but is associated with a higher duration of operation. The application of LPL in patients with multiple stones carries a lower achievement and is not encouraged. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn stones. However, residual stones in calyces remain a challenge due to the limited angle which makes the approach difficult. The new operative technique of endoscopic combined intrarenal surgery (ECIRS), which integrates the advantages of PCNL and retrograde intrarenal surgery (RIRS), was developed to overcome this difficulty. However, two experienced urologists are required to perform ECIRS, and the patient has to be placed in the Galdakao-modified supine Valdivia position or modified prone split-leg position which cannot be achieved in the elderly or patients with ankylosing arthritis, as it may cause harm due to abnormal traction of the joints. In addition, it is difficult for surgeons to create an ideal access tract to perform PCNL in this position. We report the case of a 72-year-old female patient with left staghorn stone. We performed RIRS first and then placed the patient in the decubitus position for PCNL with antegrade flexible ureteroscopy. This method allows patients to be placed in an easier position, with the use of flexible ureteroscopy through a nephroscope to find previously unreachable stones. Moreover, in addition to the more comfortable position both for surgeons and patients, this procedure can also deal with large complex renal stones as with ECIRS. We also created a brand-new definition for stone clearance rate, namely, stone reduction efficiency (SRE). There was a high stone reduction efficiency of 12.64 (mm2/min) in our patient, and no complications occurred. We suggest that this procedure is an ideal alternative treatment for a huge staghorn stone instead of PCNL or ECIRS.

Massood Hosseinzadeh, Sahand Mohammadzadeh Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Sahand MohammadzadehDepartment of Pathology, Shiraz University of Medical Sciences, Shiraz, IranTel +989173078147Fax +9871323017Email mohammads@sums.ac.irAbstract: Primary Squamous cell carcinoma (SCC) of the kidney is rarely reported in the literature. It is usually associated with renal stone, and due to lack of clinical symptoms and radiological diagnostic features, patients often present at the late stages of the disease. We reported a 59-year-old woman presented with a longstanding history of flank pain and hematuria. Imaging techniques revealed enlargement of the right kidney associated with multiple staghorn stones. The patient subsequently underwent right radical nephrectomy, and histopathological examination of the mass revealed well-differentiated keratinized squamous cell carcinoma. There was no primary source for her SCC. Although the primary SCC of the kidney is a rare entity, it should be considered in patients with longstanding renal calculi, particularly for large staghorn stones of renal pelvis. On the other hand, conventional imaging could not detect this type of malignancy. In most cases, CT and MRI play an essential role in the diagnosis of such tumors.Keywords: squamous cell carcinoma, kidney, staghorn stone

This study assesses the feasibility and effectiveness of using a three-dimensional (3D) printing model for preoperative planning in the treatment of full staghorn stones, specifically in the selection of the most optimal calyx for puncture. Twelve patients were enrolled in this trial. A preoperative CT taken in prone position was performed on each of the patients. 3D models were reconstructed using digital imaging and 3D printers. Three identical models were printed for each patient. Three puncture sites from the upper-, middle-, and lower-pole calyces of the kidney models were selected for simulation of percutaneous nephrolithotomy. The stone-free rates were recorded after each of the simulations. The puncture site that yielded the maximum SFR was translated to the patient for the actual procedure. CT was performed postoperatively on both patients and simulation models. The SFR of patients and simulation models was compared. Correlation analysis and consistency analysis suggested that there was a high degree of consistency between patients and 3D-printed models. The Pearson product-moment correlation coefficient r for the postoperative stone volume of the patients (PoSVP) and postoperative stone volume of the models (PoSVM) was 0.972 (P < 0.001, 95% CI = 0.900–0.992). The Bland–Altman plot of PoSVP to PoSVM showed an icon of 95% consistency 205.8(− 725.5 ~ 1137.1), and 100% of the points were within the 95% limits of agreement. 3D-printed models can potentially be used for preoperative planning in the treatment of full staghorn stones, especially in the selection of the most optimal calyx for puncture. [ABSTRACT FROM AUTHOR]

Congenital bilateral absence of the vas deferens (CBAVD) is a rare obstructive anomaly contributing to male factor infertility. Various congenital anomalies associated with CBAVD involve the seminal vesicles and epididymis. Physical examinations are often not reliable. However, transrectal ultrasonography (TRUS) can distinguish seminal vesicle and epididymal anomalies. In this clinical report, a rare case of CBAVD without seminal vesical anomalies is presented. PE and TRUS revealed no remarkable findings. The patient underwent vaso-epididymal anastomosis for the seminal tract obstruction and was accidentally diagnosed with CBAVD. Although ultrasonography is a reliable approach, surgical methods are critical for the diagnosis of CBAVD.

Staghorn stones are large branching stones that fill part of all of the renal pelvis and renal calyces and they can be complete or partial depending on the level of occupancy of the collecting system. Although kidney stones are commoner in men, staghorn stones are less often reported in men compared to women and they are usually unilateral. Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Conversely, conservative treatment has been shown to carry a mortality rate of 28% in 10-year period and 36% risk of developing significant renal impairment. Staghorn stones are, therefore, significant disease entity that should be managed aggressively and effectively. Generally, the gold standard treatment for staghorn stones is surgical with a view to achieve stone-free collecting system and preserve renal function. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones. Other non-surgical options are usually considered in combination with surgery or as monotherapy only if patients are surgically unfit. The decision for optimal treatment of staghorn stones should be individualized according to the circumstances of the patient involved and in order to do so, a closer look at the advantages and disadvantages of each option is necessary.

We here report a rare case of congenital megapolycalicosis in a 14-year-old girl complicated by a 24-mm staghorn stone and numerous calculi at the level of all caliceal groups that had become symptomatic in recent weeks with malaise, hematuria, and urinary tract infection. Among the various therapeutic options, we opted for open surgery. The staghorn stone was removed by pyelotomy, and washout of the caliceal cavities released numerous microcalculi of 1.5-9 mm in size that were then removed. To our knowledge, this is the first case of pediatric megacapolycalicosis complicated by staghorn stone, which presents complex problems for the diagnosis and therapy. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous nephrolithotomy (PCNL) is traditionally performed on an inpatient basis. We determine the safety and outcome of day-surgery PCNL by experienced surgeon hands. Patients and methods: A protocol for day-surgery PCNL was undertaken. A retrospective analysis of all 86 cases of planned day-surgery PCNL accomplished by an experienced surgeon who followed this protocol between May 2017 and March 2019 was performed. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery PCNL was defined as discharge of patients either the same day or within 24 h after surgery. Results: The average stone burden was 361.1 mm2 and 70 (81.4%) of patients had multiple stones or staghorn stones. 82 (95.4%) patients achieved same-day discharge or received overnight observation prior to discharge, and 4 patients (4.6%) required full admission (longer than 24 h). The readmission rate was 2.3% (2 patients). The postoperative complications occurred in 10 (11.6%) patients, including 7, 2, 2 of grade I, II, III complications. The average operation time was 64 min and the hemoglobin drop was 15.7 ± 16.9 g/L. The established tracts size ranged from 16 to 22Fr. The stone clearance rate was 90.7%. The tubeless without nephrostomy tube was performed in 60.5%. Eight cases were performed by multiple-tracts PCNL with 2–4 tracts, with only two case required full admission. Conclusion: Experienced surgeons who performed day-surgery PCNL experience excellent patient outcomes in appropriately selected patients. Most complications can be treated conservatively and only a few required intervention or readmission. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of percutaneous mini-nephrolithotomy (mini-PCNL) in children with complex staghorn stones. Patients and Methods: We analyzed prospectively data of 28 children undergoing pediatric mini-PCNL during a period of 18 months. Stone complexity was defined according to the validated Guy's stone score (GSS). Our patients were GSS III and IV. All PCNL procedures were performed in the prone position, under fluoroscopic guidance, and in the same standardized fashion with F12 and F17 mini-nephroscopes. Results: Eleven children were boys (total n = 28). Mean age was 7.25 ± 3.27 (2–14) years. Mean stone burden was 36.89 ± 8.002 (30–60) mm. GSS was in 57% grade III and in 43% grade IV. The initial stone-free rate was 78%, which increased to 89% after few ancillary procedures. Seventeen percent of children had major complications (1 hydrothorax, 4 blood transfusions). On statistical analysis, stone clearance rates were found inversely dependent on stone complexity (GSS; p < 0.025). Stone burden, number of tracts, and procedure time were associated with stone complexity (p < 0.000). In turn, stone complexity (p < 0.015) and the number of tracts (p < 0.049) were significantly associated with complications. Conclusion: Mini-PCNL is effective and safe for treating complex renal stones in pediatric patients. Complication rates are acceptable and predictably stable on comparison with the literature. [ABSTRACT FROM AUTHOR]

Staghorn stones are large branching stones that fill part of all of the renal pelvis and renal calyces and they can be complete or partial depending on the level of occupancy of the collecting system. Although kidney stones are commoner in men, staghorn stones are less often reported in men compared to women and they are usually unilateral. Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Conversely, conservative treatment has been shown to carry a mortality rate of 28% in 10-year period and 36% risk of developing significant renal impairment. Staghorn stones are, therefore, significant disease entity that should be managed aggressively and effectively. Generally, the gold standard treatment for staghorn stones is surgical with a view to achieve stone-free collecting system and preserve renal function. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones. Other non-surgical options are usually considered in combination with surgery or as monotherapy only if patients are surgically unfit. The decision for optimal treatment of staghorn stones should be individualized according to the circumstances of the patient involved and in order to do so, a closer look at the advantages and disadvantages of each option is necessary. [ABSTRACT FROM AUTHOR]

Staghorn stone fills the renal pelvic and two or more branches of renal calyces. The incidence of staghorn stones is between 10 and 20 % of all urinary tract stones. We report the case of a man with right staghorn stones and renal mass who underwent right radical nephrectomy with pathology anatomy result of renal cell carcinoma (RCC). A 56-year-old man came with a complaint of right flank pain for two months. Physical examination is within normal limits, but an abdominal CT scan revealed a staghorn stone with enhancing mass in the upper pole of the right kidney. Patient subsequently underwent right radical nephrectomy. Pathology examination revealed RCC. The presence of kidney stones in renal malignancy is rare. Kidney stones can be a risk factor for renal cell malignancy, and renal cell malignancies can cause urinary stasis, making it a risk factor for kidney stones. A study conducted by Nugroho and colleagues concluded that renal and caliceal biopsy should be considered in large and chronic renal stone due to potential experiencing kidney malignancy in patient with renal stone. Therefore, early diagnosis and definitive can be carried out. Kidney stones and malignancy are rarely found. Renal pelvis, and caliceal wall biopsy should be considered in chronic and large renal stone, especially staghorn stone in patient that did not have any signs of malignancy on CT scan. Treatment in such case is focused on the oncological outcome. Therefore, radical nephrectomy is the treatment of choice. • Coexistence of renal cell carcinoma (RCC) and staghorn stone is a rare case. • Biopsy of renal pelvis and calyx walls should be considered for old/chronic and large stones, especially staghorn stone. • Radical nephrectomy is the treatment of choice for patient with RCC and staghorn stone. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous nephrolithotomy (PNL) is the primary treatment modality for management of staghorn stones. PNL in supine position has important advantages over prone positon. However, studies comparing prone and supine positions for PNL in staghorn stone patients have conflicting results, and the aim of the current study was to compare prone and supine positions for PNL in staghorn stone cases. Patients and methods: Data of patients underwent PNL for staghorn stones in supine or prone position by a single urologist were collected prospectively. The supine and prone position groups were compared for stone free rate (SFR) and complication rates. All patients were evaluated with NCCT for evaluation of SFR. Chi-square test was used to compare categorical variables and Student t test was applied for continuous variables of the treatment groups. Results: The groups were similar for demographic and stone-related characteristics. Multi-caliceal and intercostal access was more common in prone position. Operation duration was significantly shorter and hemoglobin drop was significantly less in supine group. SFR was 64.1 and 60.4% in the supine and prone groups, respectively ( p = 0.72). Complication rates were similar in the two groups but Clavien III complications were observed in two patients in the prone group. Conclusions: PNL in supine position is an effective treatment for management of staghorn stones. The need for multi-caliceal and intercostal puncture is less when combined with retrograde intrarenal surgery. PNL in supine position should be considered as primary treatment option in staghorn stone cases. [ABSTRACT FROM AUTHOR]

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Objective: To compare the stone free rates on patients with staghorn, renal pelvic, and inferior calyx stones with stone burden < 20 mm, 21-30 mm, and > 30 mm following percutaneous nephrolithotomy (PCNL) in Cipto Mangunkusumo General Hospital Jakarta. Material & methods: The data were collected retrospectively from PCNL medical records in Cipto Mangunkusumo General Hospital Jakarta between January 2000 and March 2011. Six hundred and twenty-three patients with 651 kidney stones underwent PCNL. The inclusion criteria were staghorn stones, renal pelvic stone, and inferior calyx stone. All cases outside these three criteria and incomplete data were excluded. Stone free status was defined as no residual fragment on radiography or ultrasonography. Results: As many as 364 kidney stones from 344 patients were included, with 47.8% cases of staghorn stones, 31.9% cases of renal pelvic stones, and 20.3% cases of inferior calyx stones. Overall, 273 (75%) cases were defined as stone free. In group < 20 mm, 4 staghorn stones (100%), 18 renal pelvic stones (81.8%), and 34 inferior calyx stones (94.4%) were cleared (p = 0.811). In group 21-30 mm, 20 staghorn stones (95.2%), 52 renal pelvic stones (91.2%), and 26 inferior calyx stones (92.9%) were cleared (p = 1.000). In group > 30 mm, 83 staghorn stones (55.7%), 28 renal pelvic stones (75.7%), and 8 inferior calyx stones (80%) were cleared (p = 0.037). Conclusion: PCNL is an important tool for treating various kinds and sizes of kidney stones with high stone free rate.

Objective. The aim of this study was to report a therapeutic approach comprising a combination of debulking single-tract percutaneous nephrolithotomy (PCNL) and subsequent retrograde intrarenal surgery (RIRS) for treatment of staghorn stones in patients with solitary kidney. Materials and methods. A retrospective review was undertaken of 56 patients with staghorn stones in a solitary kidney who underwent the above-mentioned combination therapy. PCNL was first performed for stone debulking and RIRS was then used to remove residual stones after an interval of 2-4 days. Data were collected on operative parameters, stone-free rate (SFR), complications and renal functions. Results. The staghorn stones had a mean stone burden of 2548 ± 1028 mm2 (range 1438-3956 mm2). The SFR after 3 months was 89.3%. The overall blood transfusion rate was 7.1%. Complications were observed in nine patients (16.1%), including selective renal artery embolization, fever, gross haematuria and steinstrasse in one, two, three and three cases, respectively. At a mean follow-up of 31 months, available in 38 patients, kidney function was stable in 71%, improved in 26.3% and worsened in 2.7%, according to serum creatinine levels that remained within ±20%, or that increased or decreased outside this range. No patient required haemodialysis. Conclusions. Combining single-tract PCNL with subsequent RIRS was an effective strategic option for treating staghorn stones in solitary kidneys. The method gave an excellent SFR, satisfactory preservation of renal function, reduced bleeding risk and potentially less morbidity than that associated with multiple-tract PCNL. [ABSTRACT FROM AUTHOR]