Open stone surgery: is it justified in the era of minimally invasive therapies?

Abstract

Objective To summarize the efficacy of open stone surgery for renal and ureteral calculi, and to investigate the current indications for upper urinary tract stones treated by open stone surgery. Methods To analyze retrospectively the cases with upper urinary tract calculi treated by open stone surgery from January 1995 to December 2004. Results In all,there were 667 patients treated for renal and ureteral calculi by open stone surgery, at the same time 9000 cases with upper urinary tract calculi also treated in our centre with open surgery rate 7.4%. Indications for open surgery were complex stone burden of 297 cases, nephrectomy for non-functioning kidneys of 137 cases, with anatomical abnormalities of 134 cases, ESWL or endoscopy failure of 57 cases ,with co-morbid medical diseases of 30 cases,with renal carcinoma of 5 cases, with xanthogranulomatous pyelonephritis of 3 cases,with kidney injury of 2 cases, and with other ipsilateral operation of 2 cases. Of 145 cases for nephrectomy, 16 patients and 6 patients suffered from various intraoperative and postoperative complications respectively; of 522 patients treated by open stone surgery, 7 patients and 34 patients were suffered from various intraoperative and postoperative complications respectively;57 patients with multiple renal calculi had residual calculi with overall stone-free rate 89.1%. And no case died in perioperative period. Conclusious Open surgery maintains its important role for treatment of renal and ureteral calculi because of its salty and efficacy. Nephrectomy for nonfunctioning kidney with renal and/or ureteral calculi, huge and complex renal calculi, anatomical abnormalities, minimal invasive therapies failure and some selective patients with co-morbid medical diseases are suitable for open stone surgery with high success and low morbidity rate. Key words: Urinary calculi; Surgical procedures,operative; Treatment outcome