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2017 ; 11
(5
): PC01-PC04
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Anatrophic Nephrolithotomy in the Management of Large Staghorn Calculi - A Single
Centre Experience
#MMPMID28658843
Keshavamurthy R
; Karthikeyan VS
; Mallya A
; Sreenivas J
; Nelivigi GG
; Kamath AJ
J Clin Diagn Res
2017[May]; 11
(5
): PC01-PC04
PMID28658843
show ga
INTRODUCTION: With advances in endourology, open stone surgery for staghorn
calculi has markedly diminished. Anatrophic Nephrolithotomy (AN) is performed for
complex staghorn stones which cannot be cleared by a reasonable number of
Percutaneous Nephrolithotomy (PNL) attempts. AIM: To assess the indications and
outcomes of AN in the modern era. MATERIALS AND METHODS: Between April 2008 and
July 2015, AN was done in 14 renal units in 13 patients. In this retrospective
study, demography, stone characteristics, operative details, clearance and long
term outcomes were assessed. RESULTS: AN was performed for complex staghorn
calculi involving pelvis and all calyces in 10 patients, infundibular stenosis in
two patients and failed PNL in one patient. Mean (SD) in situ cold ischemia time
was 47.64 (5.27) minutes. Retroperitoneal drain and double J stent were placed in
all 13 patients. Median (IQR) estimated blood loss was 130 (75) ml. There was no
perioperative mortality. Surgical site infection was seen in 2 patients and
urosepsis in 2 patients. Drain was removed at a mean (SD) of 9.11 (6.15) days.
Mean (SD) postoperative length of hospitalization was 15.44 (7.14) days. Stent
removal was done in all patients between 2-8 weeks. Median (IQR) clearance was 95
(7.5%). There was no renal failure or new calculi during the follow up period
{median (IQR): 1(3) years}. CONCLUSION: AN is effective in management of large
staghorn calculi failed minimally invasive approaches and achieves 80%-100%
clearance without much need for secondary interventions. Renal function is
preserved and with emergence of laparoscopy and robotics, postoperative stay is
minimized with expedited recovery and comparable results with open surgery.