Management of staghorn calculus: Analysis of combination therapy and open surgery

Objective: To assess the role of primary open surgery versus the recommende d combination approach (percutaneous and lithotripsy) to treat staghorn cal culi in a developing country. Patients and Methods: Available records (n = 91) of patients with staghorn managed during the last 4 years were retrieve d. Patients were placed in two groups, open surgery and combination group, according to the primary procedure chosen by the patient. Demographic data in two groups was comparable in most of the respects except that renal fail ure patients were more in the combination group. Stone clearance, major res idue, auxiliary procedures, morbidity, hospital stay and the cost were stud ied in the two groups for comparison. Results: Complete clearance could be obtained in 66 and 59% with open and combination method respectively. Major residue (>16 mm(2)) was present in 21% of open and 38% of the combination group. In patients with primary stone burden <900 mm(2), the total clearanc e rates were 66 and 60% in open and combination group, respectively. Total clearance was not affected by caliceal dilatation, total stone burden, pelv ic and caliceal bulk separately or their ratio, as arrived by logistic regr ession analysis. The incidence of haematuria in the combination group was m arginally higher, probably due to more renal failure patients in this group . Hospital stay in the two groups was comparable (13.0 days in combination vs. 12.1 days for open). The cost of treatment with combination group was s ignificantly higher. Conclusion: Open surgery for staghorn is still an econ omically viable option for difficult stone disease, specially in a developi ng country, with comparable efficacy, favourable morbidity and hospital sta y. Copyright (C) 2000 S. Karger AG, Basel.