Modified anatrophic nephrolithotomy: A useful treatment option for complete complex staghorn calculi

• Published in: Canadian journal of urology Vol. 13; no. 5; p. 3261
• Main Authors: Ramakrishnan, Prem A, Al-Bulushi, Younis H, Medhat, Mohammed, Nair, Priti, Mawali, Salma G, Sampige, Venkat P
• Format: Journal Article
• Language: English
• Published: Canada 01.10.2006
• Subjects: Adolescent; Adult; Aged; Female; Humans; Kidney - diagnostic imaging; Kidney - pathology; Kidney Calculi - diagnostic imaging; Kidney Calculi - pathology; Kidney Calculi - surgery; Length of Stay; Male; Middle Aged; Radiography; Treatment Outcome; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - methods
• ISSN: 1195-9479

Management of complete staghorn calculi represents a challenging problem for urologists. We describe our technique and clinical experience with modified anatrophic nephrolithotomy in patients harboring large, extensively branched staghorn calculi. From October 1996 to February 2005 twenty-six patients with complete staghorn calculi defined as filling the entire collecting system or at least 80% of it, were treated employing a modification of the classical anatrophic nephrolithotomy technique. The mean patient age was 46 (range 16-70) years and the mean stone size was 3150 (range 1375-4800) mm2. Intra-operative data, complications and stone-free rates were recorded. Long-term follow-up was completed in 22 patients with a mean duration of 38 (range 12-96) months. Renal function was evaluated by 99mTc dimercapto succinic acid renal scintigraphy before and 6 months after treatment. The mean ischemia time was 36 (range 20-45) minutes, mean operative time was 195 (range 170-235) minutes and the mean blood loss was 475 (range 300-750) ml. Length of hospital stay averaged 8.8 days. One patient developed significant hematuria requiring renal angiography and embolization of a pseudoaneurysm. Overall, 22 patients (85%) were rendered stone-free at discharge while 23 patients (88%) were observed to be stone-free after 3 months. Long-term follow-up demonstrated recurrent stone fragments less than 4 mm in three patients. Isotope studies revealed that renal function remained unchanged in 55%, improved in 32% and became worse in the small number of remaining patients. Modified anatrophic nephrolithotomy is a valuable treatment option for patients with complete staghorn calculi. Because of its efficacy, safety and simplicity we believe that the use of this surgical procedure is warranted in patients with a large, extensively branched, complex renal stone burden.