Abstract
Introduction. Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Nevertheless in our experience, open surgery still represents the treatment of choice in rare cases. Case Report. A 71-year-old morbidly obese female patient complaining about occasional left flank pain, and recurrent cystitis for many years, presented bilateral staghorn kidney stones. Comorbidities were obesity (BMI 36.2), hypertension, type II diabetes, and chronic obstructive pulmunary disease (COPD) hyperlipidemia. Due to these comorbidities, endoscopic and laparoscopic approaches were not indicated. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was 180 minutes. Blood loss was 500 cc. requiring one unit of packed red blood cells. Hospital stay was 7 days. The renal function was unaffected based on preoperative and postoperative serum creatinine levels. Stone-free status of the left kidney was confirmed after surgery with CT scan. Conclusions. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases. A discussion of the current indications in the twenty-first century is presented.
Highlights
Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones
In the era of mininvasive treatments, laparotomy is rarely required, but it is important to recognize patients in whom open anatrophic nephrolithotomy could represent a valid choice of treatment [11]
extracorporeal shock waves lithotripsy (ESWL) and Endoscopic treatment have virtually eliminated the need for open surgery in kidney and ureteral stones [1, 2]
Summary
Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases. The majority of patients required an open surgical approach, today less invasive procedures, such as extracorporeal shock waves lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotripsy (PNL), have promoted a rapid decrease of the use of open surgery for both ureteral and renal stones [1, 2]. The subsequent introduction of laparoscopic approach has almost eliminated the need for open operations in the treatment of renal and ureteral stones. In the era of mininvasive treatments, laparotomy is rarely required, but it is important to recognize patients in whom open anatrophic nephrolithotomy could represent a valid choice of treatment [11]. This paper presents one of such patients as well as a discussion of the modern indications for this technique
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