Management of unilateral staghorn renal stones with concurrent urinary tract infections by retroperitoneal laparoscopic pyelolithotomy with prolonged renal posterior lower segment incision

Open surgery versus percutaneous nephrolithotomy for management of staghorn calculi

BACKGROUND

For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open surgery in different populations but these results were controversial. Here, we aimed to compare and evaluate the results of open surgery and PCNL in the treatment of staghorn stones.

METHODS

This retrospective descriptive study was performed to compare the results of open surgery and PCNL in the treatment of staghorn stones in 2013-2021. A total of 360 participants were studied among the population. Demographic data of patients including age, gender, and comorbidities were obtained. We assessed variables including type of stone, serum creatinine, degree of hydronephrosis, and urine culture before the operation. All participants in our study were informed of the two surgical alternatives.

RESULTS

The mean length of hospital stay in PCNL patients was 3.88 ± 1.76 and in open surgery patients was 5.858 ± 2.12 (P = 0.003). In 30 patients (13.9%) in the PCNL group and 27 patients (18.8%) in the open surgery group, bleeding necessitating blood transfusion was the only intraoperative complication. 309 patients (85%) had no residual stones at the time of discharge from the hospital, which was 81.9% (177 cases) in patients treated with PCNL and 91.6% (132 patients) in the open surgery group (P > 0.05).

CONCLUSION

Staghorn calculi can be managed effectively with open surgery or PCNL. Given the reduced postoperative complication rate and higher stone-free rate, we believe open surgery is better technique for complicated staghorn stones with a high burden.

Analysis of Urinary Pathogen Cultures and Drug Sensitivity in Patients with Urinary Stones for Five Consecutive Years in Xiangya Hospital, China

Objective

To analyze pathogen distribution and drug sensitivity in patients with urinary calculi and thereby gain insight into the most appropriate antibacterial drugs for perioperative therapy.

Materials and Methods

From January 2014 to December 2018, the results of mid-stream urine pathogen culture and drug sensitivity tests were evaluated retrospectively for 353 patients with urinary calculi. SPSS software version 23.0 was used to analyze the data.

Results

A total of 353 strains of pathogens were isolated from urine culture. Among these, 278 (79%) strains belonged to the top 10 most frequently isolated pathogens, comprising 209 (75.2%) Gram-negative bacilli and 69 (24.8%) Gram-positive cocci. Escherichia coli was the most frequently isolated pathogen overall and the most frequently isolated Gram-negative bacillus, and Enterococcus faecalis was the most frequently isolated Gram-positive coccus. Drug sensitivity levels were effectively unchanged for less commonly used drugs, whereas drug resistance rates remained high for commonly used drugs such as ampicillin trihydrate, ampicillin/sulbactam, cefazolin, ceftriaxone, aztreonam, levofloxacin and ciprofloxacin.

Conclusion

E. coli and E. faecalis remain the most common Gram-negative bacillus and Gram-positive coccus uropathogens, respectively, in patients with urinary calculi. Mid-stream urine pathogen culture and drug sensitivity tests should be used to select appropriate antibacterial drugs before treatment, particularly for perioperative patients with urinary calculi.