A Decade-Long Experience of Open Anatrophic Nephrolithotomyn for Staghorn Renal Calculi

Abstract

Introduction: Staghorn stones of the kidney represent complex stone configuration. Monotherapy with PCNL, ESWL and RIRS does not give complete stone clearance. Anatrophic nephrolithotomy (AN) is one of those modalities that can give complete stone clearance. Stone free rates achieved with AN is 80-100% and is better or comparable with other modalities. We share our experience of the complex surgery in the last one decade.

Materials and methods: We did a retrospective descriptive study from January 1^st 2013 to December 31^st 2022. 174 patients underwent AN for staghorn calculi. All the patients were assessed and relevant blood, urine and radiological investigations done. We used descriptive statistical analysis.

Results: We performed 1428 procedures for renal staghorn calculi in last 10 years. Anatrophic nephrolithotomy was performed in 174 cases. The mean age of the patients was 42.16 years with a male to female ratio of 1.21. The size of the staghorn stone ranged from 40 to 76 mm. The mean surgical time was 178 minutes with warm ischemia time of 27.5 minutes. We had intra-operative complications in 6.32% of the cases. 39 patients developed complications with majority being the wound infection. 22 patients had residual stones, which needed an ancillary procedure. Nephrectomy was not needed in any patient.

Conclusion: Anatrophic nephrolithotomy is a reasonably good approach to staghorn renal calculi in selected cases. The stone free rate is comparable with other approaches. Cases with multiple previous endourological failures and complete staghorn calculi benefit the most by the standard open approach.