To assess the safety and efficacy of anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy in the treatment of complete staghorn renal calculi.

A retrospective analysis was performed of 18 patiets with complete staghorn renal calculi who were treated by anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy in Affiliated Xuzhou Clinical College of Xuzhou Medical University from July 2014 to January 2017. After percutaneous nephrolithotomy, there was no residual stones in the field. Then flexible ureteroscopy was used to investigate all renal calyces, and the residual renal calculi were treated with holmium laser. The success rate of operation, stone clearance rate, intraoperative blood loss, operative time, and postoperative complications were analyzed.

Fifteen patients had a complete surgery; there were no residual stones in 10 (66.7%) cases postoperatively, and shock wave lithotripsy successfully discharged calculi in five cases who had a small amount of residual stones. Flexible ureteroscopy was not applied in two patients because of obvious bleeding during percutaneous nephrolithotomy. One patient underwent nephrostomy because of pyonephrosis. Estimated intraoperative blood loss was (210.0±50.0) ml, and operative time was (65.0 ± 20.5) min. Fever occurred in five patients, which relieved after routine treatment. One patients developed fever chills, which was cured after strengthened anti-infection treatment. One patient developed renal artery aneurysm and was managed by interventional embolization. The remaining patients did not develop serious bleeding, and stoma drainage catheters were removed in 5-7 days.

Anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy is an effective treatment for complete staghorn renal calculi.