الفهرس 
Introduction & Aim of workOnly 14 pages are availabe for public view
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Abstract
Purpose: To study the role of open surgery versus PCNL in the treatment of complete staghorn stones in a prospective randomized manner and to evaluate the role of PCNL in the treatment of borderline and partial staghorn stones and open surgery in the treatment of giant staghorn stones. Patients and methods: The study involved 145 patients with 166 branching renal stones. There were 30 borderline and 24 partial staghorns treated by PCNL, 88 complete staghorns randomized either for PCNL (n = 43) or open surgery (n = 45) and 24 giant staghorns treated by open surgery. Operative details, complications, hospital stay and stone clearance rates were recorded. All patients were evaluated at least 3 months after discharge or after last ESWL session. Results: In borderline and partial staghorns, the mean operative time was 79.4 and 82.1 minutes, blood transfusion rate was 6.7% and 8.3 % and complications developed in 13.3% and 12.5% of patients respectively. At discharge, 50% and 48.8% of renal units were stone free, 26.7% and 33.4 % had CIRFs while 23.3% and 20.8% had CSRFs. At follow up, 73.3% and 70.8% were stone free, 23.3% and 29.2% still have CIRFs while 3.4% in the borderline group developed stone recurrence. In the complete staghorn stones, PCNL was superior to open surgery in regard to intraoperative complication rate, operative time, hospital stay and period required to return to normal activities. PCNL was comparable to open surgery in the term of blood transfusion rates, stone free rates at discharge, and rates of CSRFs. At follow up both groups were comparable as regard to stone free rates and functional outcome. In the giant staghorn stones, complications occurred in 19 patients (79.2%). The mean hospital stay was 12.3 days and at discharge 50% were stone free, 29.2% had CIRFs and 20.8% had CSRFs. At follow up, 62.5% of renal units were stone free, while 37.5% still have CIRFs. Conclusion: PCNL is a valuable treatment option for complete staghorn stones with stone-free rate approaching that of open surgery. Moreover, it has the advantages of lower morbidity, shorter operative time, shorter hospital stay and earlier return to work. PCNL is the treatment of choice for borderline and partial staghorn stones while open surgery is the optimal treatment for giant staghorn stones.