Comparison of the Outcomes between Ultrasound-Guided PCNL in Lateral Position and Open Nephrolithotomy for Patients with Staghorn Renal Stones

Objective: To compare the clinical outcomes of ultrasound-guided percutaneous nephrolithotomy (US-PCNL) in lateral position and anatrophic nephrolithotomy (ANL) in the treatment of staghorn renal stones.Methods: This study includes individuals with staghorn renal stones who had an operation at Buri Ram Hospital in Thailand between October 2016 and July 2020. They were divided into two groups; group I includes patients undergoing US-PCNL (n= 114) and group II includes patients undergoing ANL (n=112). The outcomes regarding stone-free rates, the stone clearance rate, operative times, length of hospitalization, and complications were collected and analyzed.Results: The patient’s demographics and stone characteristics were not significantly different between the two groups, except that the ANL group had more preoperative hydronephrosis (78.6% vs. 53.5%, p < 0.001). Regarding the primary outcome, the stone-free rate was significantly lower in the US-PCNL group (47.4% vs. 75.9%, p < 0.001), whereas the stone clearance rate was not significantly different (96.4±6.0% in the US-PCNL group and 97.7±5.8% in the ANL group, p = 0.098). The major and minor complications between the two groups were not significantly different; however, the US-PCNL group had a significantly lower transfusion rate than the ANL group (3.5% vs. 17.9%, p < 0.001). The total operative time in both groups was not different; however, the length of stay at hospital for the US-PCNL was significantly shorter than for the ANL group (10.0 vs. 12.9 days, p = 0.002).Conclusion: The ANL had a higher stone-free rate; however, the stone clearance rate was not significantly different between the US-PCNL and ANL groups. There were many advantages of the US-PCNL over the ANL, such as less blood transfusion, shorter length of hospitalization, and no radiation exposure for the patients or the medical personnel, while the complications were not different between the two groups.