# Complications of Mini-Percutaneous Nephrolithotomy for Staghorn Stones

## TL;DR

Mini-PCNL is a less invasive kidney stone treatment that is effective for staghorn stones with acceptable risks and high success rates.

## Contribution

The study provides evidence on the safety and effectiveness of mini-PCNL for staghorn stones in a local context.

## Key findings

- Mini-PCNL achieved a stone-free rate of 84.2% in patients with staghorn calculi.
- Intraoperative complications occurred in 18.3% of cases, with hemorrhage being the most common.
- Postoperative complications included fever/infection (16.7%) and urosepsis (4.2%).

## Abstract

Background and objective

Staghorn calculi are big, intricate kidney stones that reside in the calyceal and renal pelvis. They present serious surgical difficulties and a high risk of complications. A less invasive option to standard percutaneous nephrolithotomy (PCNL), mini-percutaneous nephrolithotomy (mini-PCNL) uses smaller tract diameters to minimize bleeding, postoperative pain, and hospitalization while preserving similar stone-free rates (SFR). However, there is still little proof of its effectiveness and safety for staghorn stones, especially in local contexts. This study aimed to assess clinical results and SFR of mini-PCNL, as well as intraoperative and postoperative complications in patients with staghorn calculi.

Methods

We conducted a prospective observational study from January 2024 to March 2025 at Mardan Medical Complex and the Institute of Kidney Diseases in Peshawar, Pakistan. Mini-PCNL was performed on 120 patients aged 15 to 70 years with complete or partial staghorn calculi. Non-contrast CT scans were used as part of the preoperative evaluation to determine renal architecture and stone burden. The Clavien-Dindo system was used to categorize complications, and SPSS Statistics version 26.0 (IBM Corp., Armonk, NY) was used to analyze the data.

Results

The mean age of the 120 patients was 42.3 ± 14.7 years, with 68 (56.7%) male and 52 (43.3%) female. Complete staghorn calculi were seen in 72 (60%) of patients. Intraoperative complications occurred in 22 (18.3%). The most common complications were hemorrhage in 10 patients (8.3%) and collecting system injury in five patients (4.2%). Postoperative complications included fever/infection (n=20, 16.7%), urosepsis (n=5, 4.2%), delayed bleeding (n=3, 2.5%), and mortality (n=1, 0.8%). The SFR was 101 (84.2%), and the average length of hospital stay was 3.8 ± 1.2 days. Secondary operations were required in 12 (10%) cases.

Conclusions

Mini-PCNL is a safe and effective approach for managing staghorn calculi, achieving high SFR with acceptable complication profiles. Optimized perioperative care and infection control remain critical for favorable outcomes.