A preliminary study on laparoscopic anatrophic nephrolithotomy for renal staghorn stone

Abstract

Objective To evaluate the feasibility and effectiveness of laparoscopic anatrophic nephrolithotomy (LAN) managing renal staghorn stone. Methods Forty patients whose age ranged from 17 to 73 years (median 46 years), who underwent LAN for renal staghorn stone were included in the retrospective study at Affiliated Hospital of Guizhou Medical University in the period between May 2011 and January 2015, including 24 males and 16 females. The body mass index ranged from18.4 to 27.3 kg/m2. The date of operative time, warm ischemia time, estimated blood loss, mean stone size, stone surface area, stone-free rate, rate of operative complications, postoperative hospital stay was collected. Functional imaging studies including GFR of operated kidney, serum creatinine (SCr), renal cortical thickness were obtained before the operation and compared to that of a follow-up of 6 months. Results A total of 40 patients were completed laparoscopically and none required conversion to open surgery. Operative time ranged from 87 to 142 min (median 102.5 min). The warm ischemia time ranged from 14 to 36 min (median 20.3 min). The estimated blood loss ranged from 20 to 120 ml (median 50 ml). The mean stone area (SA) ranged from 550 to 1583 mm3 (median 796 mm3). The largest diameter of the stones ranged from 34 to 72 mm (median 59 mm). The average postoperative hospital stay was (9.2±2.1) days, ranged from 6 to 12 days. The rate of operative complications was 17.5% (7/40), including 4 patients got urinary leak and 3 patients with bacteriaemia, no patients showed perioperation urosepsis, delayed renal hemorrhage, death and other severe complication. All patients cleared from their stones except 5 patients had small residual stones managed by extracorporeal shock wave lithotripsy 3 months later, of which three patients had a favorable effect and the last 2 patients got rid of small residual fragments automatically a few weeks later, the stone-free rate was 87.5% determined by KUB or CT on postoperative day 3. After a mean follow-up of 6 months, however, there was a significant mean decrease of (13.3±3.7) ml/min(P<0.05)in GFR of effected renal afterward and a significant mean decrease of 27.5μmol/L in SCr(P<0.05). Nevertheless, the atrophy of renal cortical was not obvious, the hydronephrosis was decreased compared to that of pre-treatment and with a significant improvement on renal function in all patients at follow-up IVU and CT. Conclusions The LAN is a feasible alternative for renal staghorn stone besides PCNL in minimal invasive methods for it has some advantages of high stone-free rate, less operative complications and less influence on renal function of affected kidney. Key words: Renal staghorn stone; Laparoscopic anatrophic nephrolithotomy; Operative complication