Laparoscopic anatrophic nephrolithotomy for management of complete staghorn renal stone: clinical efficacy and intermediate-term functional outcome.

Alireza Aminsharifi, Patris Hadian, Kamran Boveiri

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

To report the clinical efficacy and intermediate-term functional outcome after laparoscopic anatrophic nephrolithotomy (LAN) as an alternative treatment modality for complete staghorn renal stone. The demographic and perioperative parameters as well as the intermediate outcome of 10 adults (9 men) who underwent transperitoneal LAN for complete staghorn renal stone were analyzed. Functional imaging studies consisted of intravenous urography (IVU) and technetium-99 dimercaptosuccinic acid scintigraphy (99Tc-DMSA) renal scan done before the operation and at the last follow-up visit. Mean age of patients was 48.7 years (range 37-64 years). Mean stone size was 67.3 mm (50-90 mm). Mean operative time was 192 minutes (110-240 min), and mean warm ischemia time was 32.8 minutes (15-40 min). A few hours after laparoscopy, one patient underwent splenectomy because of significant hemorrhage from a splenic laceration (grade IIIb complication). During the follow-up period early after the operation, we detected an 8-mm lower caliceal stone and a 25-mm midcaliceal stone in one patient each (stone-free rate: 80%). After a mean follow-up of 11.9 months (6-19 mos), 85.5% of corresponding renal unit function was preserved; however, there was a significant mean decrease in 99Tc-DMSA uptake from 48.4%±8.83 before surgery to 41.4%±13.98 afterward (-7%±6.53; P=0.008). Nevertheless, renal units were completely functional at follow-up IVU with a significant improvement in obstruction in all patients. LAN is an alternative minimally invasive approach for one-session management of patients with complete staghorn renal stone. It offers an acceptable rate of stone clearance and operative complications but does incur a minimal loss of function in the affected kidney.

Original languageEnglish (US)
Pages (from-to)573-578
Number of pages6
JournalUnknown Journal
Volume27
Issue number5
DOIs
StatePublished - May 2013

All Science Journal Classification (ASJC) codes

  • Urology

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