ABSTRACT
Objective: To evaluate the role of open surgery in the management of staghorn calculi by comparing it with other available modalities of treatment i.e. percutaneous nephrolithotomy [PCNL] and extracorporeal shockwave lithotripsy [ESWL] and assessing improvement in the renal function [parenchymal thickness and glomerular filteration rate [GFR] after stone removal
Design: Institutional- based prospective study
Place and Duration of study: This study was conducted at the department of Urology, Nishter hospital, Multan from January 2000 to February 2002 [2 years]
Subjects and Methods: A total of fifty patients with staghorn calculi who underwent open surgery in the department and completed a three-month follow-up were included in the study. All patients had a complete blood examination [CBE], complete urine examination [CUE] [including culture and sensitivity [CIS], renal parameters [urea and creatinine], renal tract ultrasonography [USG] preoperatively and at first, second and third month of follow-up to assess the improvement in heamoglobin, control of urinary tract infection [UTI], parenchymal thickness and postoperative complications. Tc99m DTPA scan was employed before surgery and at third month of follow-up to evaluate the improvement in GFR for operated kidney
Results: The male to female ratio was 2.1:1, with a mean age of presentation of 42.70 years. Pain in the lumbar region [58%] was the most common presentation followed by lower urinary tract symptoms [LUTS 32%] and renal insufficiency [16%]. Fever [36%] was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. It fell to 10.21 gm at first month of follow-up but increased to 11.89 gm by the third month. . The mean GFR before surgery was 77.18ml/min, which increased to 81.56ml/min after surgery at third month of follow-up. The mean GFR of the kidney with stones was 32.46 ml/min before surgery, which increased to 39.84-ml/ min after surgery
Conclusion: Staghorn stones if left untreated lead to chronic UTI and renal insufficiency. Removal of the stone is the only way these consequences can be avoided. Nonavailability of resources, a poor health care system, the lack of PCNL and ESWL facilities and/or expertise, the cost and need for multiple sessions and/or ancillary procedures in these minimally invasive techniques and the vigorous follow-up required still make open surgery a viable and an applicable option in our socioeconomic setup