الفهرس 
SURGICAL ANATOMY OF THE KIDNEYOnly 14 pages are availabe for public view
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Abstract
pen surgery for staghorn calculi has a higher stone free rate following the primary procedure (56.7%) versus PNL (46.7%). Furthermore, the stone free rate with open surgery was markedly increased with the use of intraoperative image (C-arm).
The lack of flexible nephroscopy, the combined pneumatic/ ultrasonic or holmium laser for intracorporeal lithotripsy had a negative impact on the outcome of PNL for staghorn calculi.
Accordingly, the need for secondary procedures (ESWL or secondary PNL) to address significant residual stones was higher with PNL (40%) versus the open surgery (26.7%).
However, the need for adjunctive procedures (as double J removal or application) was higher in the open surgery group (56.7%) versus the PNL group (30%), a difference of significant value.
PNL had the advantages of shorter hospital stay (a difference of high statistical significance) and shorter operative time.
Also, the procedure related blood transfusion rate was lower in PNL (20 %) than in open surgery (26.7 %), however the incidence of a significant intraoperative bleeding was higher with PNL than in open surgery for staghorn calculi.
Open pyelo-nephrolithotomy carries a higher incidence of pleural injury, wound infection and more hospital stay period that was accompanied with development of DVT and a fatal pulmonary embolism in one case.
Both modalities were comparable in terms of the overall complication rates, the effect on the renal function, the total number of procedures to render the patient stone and stent free and the total cost of these procedures (i.e. including secondary and adjunctive procedures).
This study recommends open surgery for the management of complex multiple and giant staghorn renal calculi, especially in the working conditions of developing countries.