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Difficult Cases in Endourology pp 73–78Cite as

Percutaneous Nephrolithotomy (PCNL) for Staghorn Calculi: The Rigid Approach – Overcoming the Difficulties

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Abstract

The cornerstone of management of staghorn calculi includes complete clearance of the stone with minimal morbidity. The AUA Nephrolithiasis Guidelines mentions percutaneous nephrolithotomy (PCNL) as the treatment of choice for staghorn calculi. The management of staghorn calculi is one of the most challenging among endourologic procedures because the operating surgeon has to do the balancing act of complete stone clearance with minimal morbidity. We discuss the possible difficulties one may encounter during the procedure. The complications discussed include inability to gain access, wire kinks, wire slippage, stone migration, and bleeding. The troubleshooting in rigid approach to staghorn calculus involves proper preoperative assessment with contrast-enhanced CT scan. The basic principles of endourology which include proper vision, understanding the relevant surgical anatomy, and use of proper-sized and appropriate instruments, all help in reducing the risks involved in this approach. Timely recognition and treatment of surgical complications help in reducing the morbidity and related mortality.

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Authors and Affiliations

  1. Department of Urology, Muljibhai Patel Urological Hospital, Dr. Virendra Desai Road, Nadiad, 387001, Gujarat, India

    Arvind P. Ganpule M.S., DNB, MNAMS & Mahesh Desai M.S., FRCS

Authors
  1. Arvind P. Ganpule M.S., DNB, MNAMS
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  2. Mahesh Desai M.S., FRCS
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Corresponding author

Correspondence to Arvind P. Ganpule M.S., DNB, MNAMS .

Editor information

Editors and Affiliations

  1. Fac. Medicine, Dept. Surgery, Kuwait University, Safat, Kuwait

    Ahmed M. Al-Kandari

  2. , Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, 387 001, India

    Mahesh Desai

  3. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed A. Shokeir

  4. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed M. Shoma

  5. , Smith Institute for Urology, Long Island Jewish Health System, New York, 11040, USA

    Arthur D. Smith

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© 2013 Springer-Verlag London

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Ganpule, A.P., Desai, M. (2013). Percutaneous Nephrolithotomy (PCNL) for Staghorn Calculi: The Rigid Approach – Overcoming the Difficulties. In: Al-Kandari, A., Desai, M., Shokeir, A., Shoma, A., Smith, A. (eds) Difficult Cases in Endourology. Springer, London. https://doi.org/10.1007/978-1-84882-083-8_8

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  • DOI: https://doi.org/10.1007/978-1-84882-083-8_8

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-082-1

  • Online ISBN: 978-1-84882-083-8

  • eBook Packages: MedicineMedicine (R0)

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