Indication to open anatrophic nephrolithotomy in the twenty-first century: a case report

Open stone surgery in the treatment of bilateral complex renal stones with left infected hydronephrosis: A case report

Introduction and importance

With the strong development of percutaneous nephrolithotomy as well as other less invasive procedures, the indication of open surgery for the treatment of nephrolithiasis has been significantly reduced and is only applied in selective cases.

Case presentation

A 55-year-old male was admitted to the Department of Urology due to fever and left flank pain. Clinical examination and imaged studies reveal staghorn calculi in the right kidney and infected hydronephrosis with multiple stones on the left side. The stone removal surgery was performed in 2 sessions, left first - right after. The two operations came out with no peri- or post-operative complication, no blood transfusion.

Clinical discussion

The two reasons for the indication of open surgery instead of percutaneous nephrolithotomy were i/ the stone's sizes were very large and very hard, and ii/ the multi-tract nephrolithotomy increased the risks of blood transfusion and parenchymal's damage. Also, a long-time and difficult nephroscopy was not the good choice for the left-infected hydronephrosis.

Conclusion

Open stone surgery is still a good alternative approach for kidney complex stone burden, especially infected hydronephrosis.

•

Bilateral renal staghorn stone is an uncommon disease.

•

Open stone surgery is still a good alternative approach for kidney complex stone burden, especially infected hydronephrosis.

•

The standard flank approach and an extended pelvic incision could be enough for the stone removal.