In situ big dissection of anatrophic nephrolithotomy to remove large renal staghorn calculi:report of 52 cases / 中国医师进修杂志

Objective To discuss the method and effect of large renal staghorn calculi by anatrophic nephrolithotomy (AN).Methods Fifty-two patients with large renal staghom calculi underwent AN.Bilateral renal calculi disease was present in 3 patients,so that a number of 55 procedures were operated.Preoperative evaluation included urinalysis,urine culture,renal function,and ultragound,CT,KUB and IVU.A flank incision was between the 11th and 12th ribs and the kidney was freed.After interrupted renal pedicle in situ hypothermia,the renal parenchyma incision was made along the avascular plane which is outside in the back of the kidney.The collecting system was opened.The calculi were removed.The collecting system was reconstructed.The renal parenchyma was closed and the renal circulation was reestablished.The protected management of renal function was made intraoperative.Postoperative follow-up consisted of urinalysis,renal function,ultrasound,KUB,IVU and ECT.Results The operative time was (117±45) minutes.The renal ischemia time WaS (29±15)minutes.Five cases underwent blood transfusion.Mean amount of blood transfusion was 230 ml.Four cases had remained calculi.The stone-free rate was 92.3%.No recent complication occurred after operation.Postoperative follow-up indicated that renal function was normal.Conclusions AN is the most appropriate method for patients with large renal staghorn calculi because of the highest stone-free rate,the lowest stone-recurred rate and a safe and effective operative procedure with less complication.Renal function damages just little through a series of protected management.Nephrectomy is avoided to part of patients.

Experience in the treatment of complete staghorn calculi / 대한비뇨기과학회지

The majority of renal calculi including staghorn calculi can be treated by extracorporeal shock wave lithotripsy (ESWL) with percutaneous or endourological relief. In case of complete staghorn calculi, many treatment sessions may be required and non-operative treatment by percutaneous nephrolithotripsy (PNL) also is an invasive technique, because the insertion of a percutaneous nephrostomy tube into a calyx occupied by a staghorn calculus, placement of a safety guide wire into the ureter and dilatation of the tract are extremely difficult. From July 1985 to December 1991 we evaluated 12 patients with complete staghorn calculi in 15 kidneys for initial therapy using anatrophic nephrolithotomy. We suggest that the operative treatment should still be considered a viable treatment option, especially in patients with complete staghorn calculi.

Anatrophic nephrolithotomy: experience in 55 cases / 영남의대학술지

55 consecutive anatrophic nephrolithotomies on 53 patients performed between July, 1983 and June, 1990 were reviewed. The patients (36 male and 19 female) ranged in age from 3 to 72 years. The operation time averaged 219.8 minutes with a range of 120-330 minutes, and the ischemic time ranged between 20 and 90 minutes, with a mean of 43.5 minutes. Postoperative complications developed in 18 patients, which were such as persistent urinary tract infection in 5cases (9.4%), atelectasis in 4 (7.5%), transient urine leak in 2 (3.8%), delayed bleeding in 2 (3.8%) and urinary retention in 2 (3.8%). Postoperative residual stones were identified in 15 (27.3%), but in 8 of these 15patients stones were delivered spontaneously and thus 48 of 55 cases (87.3%) became stone free. The recurrence of stone was noted in 2 out of 48 patients during the short follow up period. Anatrophic nephrolithotomy seems to be an effective method compared to other procedure because of decreasing recurrence of stone by complete stone removal and reconstruction of abnormal collecting system.

A Clinical Observation on l0 Cases of Anatrophic Nephrolithotomy / 대한비뇨기과학회지

The surgical intervention of renal staghorn calculi was performed in 9 patients(lOkidneys) who had undergone anatrophic nephrolithotomy with in situ hypothermia. admitted to the Department of Urology, HaniI Hospital, during four years periods from June, 1982 to May, 1986. This operation technique is simple, easy but uneventful recoveries followed only in a small group. The results were summarized as followings : l. Postoperative hospitalizations were 13.1 days(ranged from 8 to 21). 2. Operating time required 194.5 minutes with mean time(ranged from 150 to 230). 3. Renal artery clamping time required 36.4 minutes with mean time(ranged from 23 to 65). 4. Blood loss during operation was 875ml on the average loss(ranged from 350 to l400). 5. Postoperative complications were nephrectomy l case, pneumothorax l case, deep vein thrombosis l cases remained stone 3 cases.

Evaluation of Anatrophic Nephrolithotomy under Hypothermia / 대한비뇨기과학회지

Twenty-four anatrophic nephrolithotomies under hypothermia were performed between June, 1980, and July, 1982, to remove staghorn and multiple renal calculi. 1. There were no operative deaths, and eight transient postoperative complications occurred. These complications resolved during their initial hospitalization, and no nephrectomies were required. 2. The average time of the operation was 4.17 hours, and the mean cold renal ischemic time was 51 minutes. The patient required an average of 1.9 pints of blood intraoperatively and no transfusion postoperatively. The average length of postoperative hospitalization was 10.3 days in all patients and 17.4 days in complicated cases. 3. Magnesium ammonium phosphate calculi were present in the major of patients (62.5%) in staghorn calculi and calcium oxalate (62.5%) in multiple renal calculi. 4. Postoperative evaluation was done in 16 of 24 patients. Seven patients (43.8%) has residual calculi. This high residual stone rate was due to lack of intraoperative roentgenography. 5. Among 16 patients, 9 had preoperative urinary tract infection. In 4 patients who had residual stone, 2 patients had perpetuated urinary tract infection and in 5 patients who had no residual stone, postoperative urine culture were sterile. 6. Intravenous pyelography was performed 3 months after the operation in 6 patients. Of these 6 patients 5 revealed stable or improved renal function. In 1 patient it revealed non-functioning kidney. We suppose it may be due to vascular spasm or injury.

Anatrophic Nephrolithotomy in Staghorn Calculi / 대한비뇨기과학회지

A retrospective study was conducted on 9 patients (10 kidney) who had undergone anatrophic nephrolithotomy for staghorn calculi. There were some complications which were such as residual stone 3 cases, renovascular hypertension 1 case, urinary fistula 1 case and wound abscess 1 case, but surgical intervention is the treatment of choice for patients with staghorn calculus disease.

Anatrophic Nephrolithotomy in Staghorn Calculi / 대한비뇨기과학회지

A retrospective study was conducted on 9 patients (10 kidney) who had undergone anatrophic nephrolithotomy for staghorn calculi. There were some complications which were such as residual stone 3 cases, renovascular hypertension 1 case, urinary fistula 1 case and wound abscess 1 case, but surgical intervention is the treatment of choice for patients with staghorn calculus disease.