Surgical outcomes of high-power holmium laser versus pneumatic lithotripsy during multitract percutaneous nephrolithotomy for the management of staghorn renal stones: A randomized comparative study

Aim
To evaluate early perioperative surgical outcomes of high-power holmium laser lithotripsy (HP-HLL) versus pneumatic lithotripsy (PL) in patients with staghorn stones undergoing multitract percutaneous nephrolithotomy (PCNL).
Patients and methods
From January 2021 till April 2022, 43 patients with staghorn stones, candidates for PCNL were enrolled in this randomized comparative study. Patients with simple renal stones, ipsilateral renal anomalies, not fit for PCNL or refusing randomization were excluded. After successful access to targeted calices, 21 and 22 patients were randomized to PL (group A) and HP-HLL (group B), respectively. Surgical outcomes were assessed in both groups.
Results
Both groups were matched as regards preoperative patients’ and stones’ characteristics (>0.05). We did not find statistically significant differences between HP-HLL and PL as regards operative time (=0.513), fragmentation time (=0.289), or duration of hospital stay (=0.721). Stone-free rate was higher but not statistically significant with HP-HLL (81.8 vs. 71.4%, =0.42). HP-HLL was associated with less intraoperative extravastion/perforation (4.5 vs. 19.1%), less perioperative blood transfusion (9.1 vs. 14.3%), and less need for intraoperative double J (DJ) indwelling stenting (9.1 vs. 28.6%) but without statistical significant differences (=0.185, 0.664, 0.101, respectively). HP-HLL was associated with less persistent leakage after removal of the nephrostomy tube without statistical significance (14.3 vs. 4.5%, =0.272). Perioperative need for DJ application was statistically significantly higher with PL (47.6 vs. 13.6%, =0.015).
Conclusion
HP-HLL is safe and effective during multitract PCNL for the management of staghorn stones. HP-HLL is associated with comparable stone-free rate and perioperative complications, but less need for perioperative DJ stenting.