Single versus Multiple Mini-tract Percutaneous Nephrolithotomy for Staghorn Renal Stone: A Single-Center Study

Jamil Ahmed Khan — Tue, 30 Sep 2025 00:00:00 +0000

Staghorn stones are difficult to treat, which may cause severe complications in the urinary tract. So surgical intervention is necessary. Objective: This study aimed to determine the outcomes of Single versus multiple mini-tract percutaneous nephrolithotomy for Staghorn Renal Stones. Methods: The present randomized controlled trial was conducted at the Department of Urology, Postgraduate Medical Institute (PGMI), Quetta, from January 2025 to June 2025, following permission from the hospital's ethical committee. Individuals of both genders and different age groups with complete or partial staghorn stones and scattered renal stones involving both renal pelvis and calyces were included. The study participants were divided into two groups: Group A and Group B. Each group has 55 individuals. Group A received a single mini-tract (21-Fr sheath) via the percutaneous method, and Group B required multiple mini-tracts (two). To determine the location, dimensions, and hardness of the stones, as well as the anatomy of the renal collecting system, for continuous variables (such as patient characteristics and perioperative data), an independent-sample t-test was employed. The perioperative findings and postoperative outcomes were compared. Statistical analysis was performed using SPSS. Results: A total of 110 individuals with satghorn stones were enrolled in this study, which were randomly divided into single (A) and multiple (B) tract PCNL groups. In a single tract, the mean stone size was 11.68 ± 8.07, whereas in multiple tracts, it was 16.24 ± 10.50. Consequently, there was a notable variation in stone size between the two groups (P = 0.005). When comparing the two groups' operative times, the mean time for a single tract was 101±11.0 minutes, while the mean time for multiple tracts was 121±23.6 minutes (p-value of 0.005). A single-tract hospital stay lasted 4.20±2.21 days, while a multiple-tract hospital stay lasted 4.21±2.10 days. Likewise, 28% of blood transfusions occurred in a single tract, while 16% occurred in multiple tracts. Clavien-Dindo was assigned to the complication of blood transfusion and bleeding, which were the most serious adverse effects associated with the multiple-tract strategy compared to single-tract therapies. Conclusion: The present study concluded that a safe and effective technique for treating staghorn kidney stones is multiple-tract access during PCNL.

Normal Pressure Hydrocephalus in the Elderly: A Narrative Review of Diagnostic Complexity, Biomarker Potential, and Surgical Outcomes

Thu, 02 Oct 2025 00:00:00 +0000

Normal pressure hydrocephalus (NPH) is a reversible cause of dementia in older adults, characterized by the clinical triad of gait disturbance, cognitive decline, and urinary incontinence. Owing to overlapping symptoms and low cerebrospinal fluid (CSF) Aβ42 levels, NPH is frequently misdiagnosed as Alzheimer's or Parkinson's disease. Objective: To provide a comprehensive narrative review of the pathophysiology, diagnostic challenges, treatment options, and prognostic markers of NPH, with a particular focus on implications for low- and middle-income countries (LMICs). Methods: Relevant literature published between 2000 and 2025 was retrieved from PubMed, Scopus, and Google Scholar using the keywords "normal pressure hydrocephalus," "cerebrospinal fluid dynamics," "ventriculoperitoneal shunting," and "biomarkers." Both clinical and experimental studies addressing NPH's pathophysiology, diagnostic modalities, and treatment outcomes were reviewed, with emphasis on studies applicable to LMIC contexts such as Pakistan. Results: Evidence indicates that disrupted CSF circulation and ventriculomegaly underlie NPH, with diffusion tensor imaging and arterial spin-labelling MRI offering diagnostic refinement. However, limited access to advanced neuroimaging and cultural perceptions of symptoms as "normal aging" contribute to underdiagnosis in LMICs. Ventriculoperitoneal shunting, particularly with fixed-pressure devices, consistently improves gait performance, while cognitive and urinary outcomes are variable. Post-shunt changes in CSF biomarkers (Aβ42, tau) and serum markers (BDNF, TRPV4) demonstrate potential prognostic value. Functional imaging further correlates reduced cerebral blood flow with symptom severity. Conclusion: NPH remains an under-recognized yet treatable neurological disorder. Increasing awareness, developing simplified diagnostic approaches, and ensuring cost-effective treatment strategies are essential to optimizing patient outcomes, particularly in resource-constrained settings.

Biological and Clinical Sciences Research Journal

Single versus Multiple Mini-tract Percutaneous Nephrolithotomy for Staghorn Renal Stone: A Single-Center Study

Normal Pressure Hydrocephalus in the Elderly: A Narrative Review of Diagnostic Complexity, Biomarker Potential, and Surgical Outcomes