[Treatment of staghorn calculi by percutaneous nephrolithotomy. Apropos of 18 cases].

This series involves 19 kidneys treated by the same operator. The predominance of women (14/18) and of proteus urinary infection (11) was identical to other published series. 13/19 calculi with complete staghorn calculi occupying the renal pelvis and the 3 calyceal groups. 7 patients had a past history of 15 lombotomies for staghorn calculus. PCLN was carried out under fluoroscopic visualisation only, in 13 cases with one single channel, in 4 cases with two channels and in 3 cases with three channels. One operative phase was sufficient in 9 kidneys, two in another 9, whilst one kidney required 3. The mean duration of irradiation was 20 minutes (as against 12 minutes for the entire series of 135 CNL of the same operator). The post-operative course was uneventful apart from late hematuria which required no particular surgical management. 14/19 kidneys (73.6%) were totally cleared of their calculi. For the other 5 kidneys, two were treated by extracorporeal lithotripsy, with one success, two were lost to follow-up, including one after refusal of a third PCNL, and one will shortly be retreated by PCNL. After analysis of the literature compared with his own experience, the author considers that approximately 90% of staghorn calculi (large portion in pelvis, small calyceal portions, wide calyceal branches) can be treated by PCNL alone or completed by ECL and that some 10% of staghorn calculi (small pelvis portion, large extensively branched calyceal portions, narrow calyceal branches) still require traditional surgery.