الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Staghorn stones are frequently struvite (magnesium ammonium phosphate) with urease-producing bacteria have linked to recurrent urinary tract infections.(69,70) Patients more likely to develop struvite stones are female, old age, people with neurogenic bladders, having type I renal tubular acidosis, medullary sponge kidneys, urinary stasis, urinary diversion, indwelling Foley catheters, and diabetes mellitus.(69-71)
Among possible treatment modalities such as ESWL combined with PCNL, open surgery , PCNL is considered now as the primary suggested treatment option of staghorn stones.(72) Clayman et al. in 1983 published the first study on the percutaneous treatment of staghorn stones.(73)
Randomized Controlled Trial (RCT) in the treatment of staghorn stones was published in 2005 and found PCNL to be superior to ESWL.(74) Another RCT, PCNL was compared to open surgery for the treatment of staghorn stones, and the results revealed similar stone clearance, less bleeding, a faster recovery period, and fewer surgical complications in the PCNL arm.(75)
Additionally, recent studies have shown that mini-PCNL is a viable choice for treating individuals with complicated kidney stones, including staghorn calculi either as one-stage or two-stage method.(76,77)
Regardless of the initial management strategy, a significant large portion of staghorn calculi required more than one step of percutaneous surgery and several percutaneous nephrostomy tracts to reach a successful outcome.(77) Complete stone removal with the least amount of morbidity is the goal of PCNL in the management of staghorn stones.(78)
The ideal method seems to be to enter either the upper or lower calyceal puncture since it provides a straight tract along the renal axis and allows easier calyceal access including renal pelvis without overtorquing the rigid instruments. To reduce the potential hydrothorax formation or lung damage, access should be obtained below the 11th rib.
In case of large or complex calculi, multiple tract punctures may be used. Single-tract PCNL and multiple tracts are equally safe and effective at clearing stones with comparable complications when used judiciously by an experienced surgeon.(78,79)
In our study we compared the single-step technique to the serial metal Alken renal dilation in patients