Modified anatrophic nephrolithotomy for complete staghorn calculus disease - Does it still have a place?

Objective: To report our experience with open surgery for the management of complete staghorn calculi using a modified anatrophic nephrolithotomy technique. Material and Methods: Between 1990 and 2001, 24 patients underwent anatrophic nephrolithotomy in our department. Bilateral complex stone disease was present in 9 patients, so that a total of 33 procedures were carried out. Preoperative evaluation included excretory urography (intravenous pyelography) and routine laboratory study in all patients and in 9 patients renal function was assessed using Tc-99m dimercaptosuccinic acid renal scans before and 6 months after surgery. Postoperative follow-up consisted of kidney-ureter-bladder (KUB), ultrasound (U/S), urinalysis and urine culture. Results: The mean operative time was 180 min, mean blood loss was 500 ml and renal ischemia time ranged between 10 and 35 min. Deep vein thrombosis occurred on the 5th postoperative day in an obese female patient. No other operative or postoperative complications were observed. Mean hospital stay was 8.2 days (range 7-12 days). The stone-free rate was 83.3%. Long-term follow up demonstrated stone fragments <4 min in diameter in 4 patients (16.6%). Renal function remained unchanged or slightly improved in 15 patients; a slight worsening of renal function was noted in 9 patients (from an average of 39% before to 35% after the procedure). Conclusions: Anatrophic nephrolithotomy, although a major operative procedure, remains the most appropriate method for the one-stage management of a selected group of patients harboring large staghorn calculi with infundibular stenosis, and is associated with the highest stone-free rates.