A new technique for removal of staghorn calculi. The pyelo-renal flap.

Abstract

The authors present a new technique for removal of staghorn calculi. The technique consists of a high pyelotomy curved towards the lower pole, completed by a partial guillotine-type nephrectomy. The pyelo-renal flap presents a large opening and a very good exposure of the lower half of the calculus including the inferior leg. The removal of the calculus is performed by pulling the inferior leg upwards and rotating it. The pyelo-renal flap is useful especially in those cases of staghorn calculi where the renal infundibuli are large enough to negotiate the passage of the respective leg which is trapped there. We insist on using digital pressure with a Penrose drain on the renal pedicle, and not using a clamp. Each bleeding vessel can be better controlled, and the period of renal ischaemia kept to a minimum. We use 500 mg of tetracycline before closing the calyx which improves the quality of the calyceal closure. The above-mentioned technique was used seven times in five patients. The post-operative period was uneventful, the patients leaving the hospital between 11–32 days.