Abstract
Anatrophic nephrolithotomy (ANL) in the selected cases represents the method of choice in the treatment of staghorn calculi. We evaluated postoperative outcome of patients subjected to standard ANL that received 10 mg of Verapamil immediately before declamping renal artery, due to prevention of reperfusion injury. From 2002 to 2005, 18 nephrolithotomies were performed on 15 patients, in the Urology Clinic, University of Sarajevo Clinics Centre. Preoperative evaluation included intravenous urography and radionuclide renal scans which had been repeated 6 months after the operations. 10 males and 5 females were operated with mean age of 45 years. Urography and renal scans showed severe calyceal distortion and infundibular stenosis in 83% cases, complicated with ureteropelvic junction obstruction in 55% cases. Chronic kidney failure was present in 60% patients. Mean operative time was 150 minutes, with mean cold ischemia time of 61 minutes and mean blood loss of 300ml. There were five minor postoperative complications. Residual small calculi were found in 3 patients. Kidney function was stabilized in the patients suffering from chronic kidney failure, which was proved by radio nuclide imaging. ANL improved by using calcium channel blockers as a protective factor for reperfusion injury proved to be a good treatment choice with a low level of complications and noticeable stabilization and improvement of kidneys function.
Highlights
Staghorn calculi are stones that fill the major part of the renal collecting system
Due to metabolic changes during renal ischemia and cooling of the kidney, there is a relative risk for renal cells to suffer from reperfusion injury ( )
To overcome this problem we introduced intravenous administration of mg of Verapamil just before declamping the renal artery, which is in accordance with the renal transplant practice ( )
Summary
Staghorn calculi are stones that fill the major part of the renal collecting system. They occupy the renal pelvis and branch into most of the calyces ( , ). Conservative treatment of these stones leads to complete renal failure. Infections with urea-splitting bacteria and residual urine ( ) as the result of anatomic abnormalities (infudibular stenosis, calyceal distortion and ureteropelvic junction obstruction) are the main cause of creation of these stones.
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