Modified anatrophic nephrolithotomy for management of staghorn calculi: is renal function preserved?

OBJECTIVE

We report the results of modified anatrophic nephrolithotomy in select patients with complex staghorn calculi.

METHODS

From 1987 to 1997 modified anatrophic nephrolithotomy, including 1 bilateral procedure, was performed in 15 patients at San Francisco General Hospital. Preoperative imaging included excretory urography, sonography and computerized tomography. Preoperative and postoperative quantitative renal function was assessed with 99mtechnetium dimercapto-succinic acid renal scintigraphy and serum creatinine measurements.

RESULTS

Mean patient age was 42 years and 11 of the 15 patients were male. Bilateral nephrolithotomy was performed in 1 patient on separate occasions. Average surgical time was 3.7 hours with blood loss of 325 ml. Length of hospital stay averaged 4 days. Residual stones were present after 3 procedures, and 1 of these patients required a secondary procedure. There were no other short-term complications. Renal function was not significantly altered.

CONCLUSIONS

Modified anatrophic nephrolithotomy for staghorn renal stones rendered most patients stone-free with concomitant preservation of renal function. Because of its safety, efficacy and simplicity we believe that continued use of this procedure is warranted in select patients with complex renal stone disease.