Modified Anatrophic Nephrolithotomy "A Salalah Experience"

Abstract

Anatrophic Nephrolithotomy is a major open Transrenal surgery of the Kidney to extract a Complete Staghorn Calculus of the Kidney in selected situations. The original procedure described by Boyce involved complex dissection of the renal vasculature with selective cannulation and perfusion of the posterior segmental artery with methylene blue. We are presenting our experience of a modified approach of the same procedure, thereby reducing the ischemic time and the morbidity of the original procedure. These modifications have been described in literature and we are presenting our experience of the same with comparable results. It is a highly skilled procedure and a proper case selection, knowledge of the Renal vascular anatomy, adequate surface cooling, is absolutely essential to have a successful outcome devoid of major immediate complications like gross bleeding and hematuria, and delayed complications like Ischemic necrosis with fistula formation and renal Ischemic atrophy. Our complications were easily manageable adopting conservative methods.