Open Access

ARTICLE

Modified anatrophic nephrolithotomy: a useful treatment option for complete complex staghorn calculi

Prem A. Ramakrishnan, Younis H. Al-Bulushi, Mohammed Medhat, Priti Nair, Salma G. Mawali, Venkat P. Sampige

Departments of Urology and Accident & Emergency, Armed Forces Hospital, Muscat, Sultanate of Oman
Address correspondence to Dr Prem A. Ramakrishnan, Department of Urology, Armed Forces Hospital, P.O. Box 726, Post Code 111, CPO Seeb, Sultanate of Oman

Canadian Journal of Urology 2006, 13(5), 3261-3270.

Abstract

Introduction: Management of complete staghorn calculi represents a challenging problem for urologists. We describe our technique and clinical experience with modified anatrophic nephrolithotomy in patients harboring large, extensively branched staghorn calculi.
Materials and methods: From October 1996 to February 2005 twenty-six patients with complete staghorn calculi defined as filling the entire collecting system or at least 80% of it, were treated employing a modification of the classical anatrophic nephrolithotomy technique. The mean patient age was 46 (range 16-70) years and the mean stone size was 3150 (range 1375-4800) mm². Intra-operative data, complications and stone-free rates were recorded. Long-term follow-up was completed in 22 patients with a mean duration of 38 (range 12-96) months. Renal function was evaluated by 99mTc dimercapto succinic acid renal scintigraphy before and 6 months after treatment.
Results: The mean ischemia time was 36 (range 20-45) minutes, mean operative time was 195 (range 170-235) minutes and the mean blood loss was 475 (range 300-750) ml. Length of hospital stay averaged 8.8 days. One patient developed significant hematuria requiring renal angiography and embolization of a pseudoaneurysm. Overall, 22 patients (85%) were rendered stone-free at discharge while 23 patients (88%) were observed to be stone-free after 3 months. Long-term follow-up demonstrated recurrent stone fragments less than 4 mm in three patients. Isotope studies revealed that renal function remained unchanged in 55%, improved in 32% and became worse in the small number of remaining patients.
Conclusions: Modified anatrophic nephrolithotomy is a valuable treatment option for patients with complete staghorn calculi. Because of its efficacy, safety and simplicity we believe that the use of this surgical procedure is warranted in patients with a large, extensively branched, complex renal stone burden.

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