Introduction. Anatrophic nephrolithotomy is a procedure in which a parenchymal incision is made in an intersegmental plane, allowing removal of large renal. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was minutes. Blood loss was cc. requiring one. The anatrophic nephrolithotomy described by Smith and Boyce is an excellent method of preserving a maximum number of functioning nephrons by minimizing .
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Three patients had residual stones [ 6 ]. It could be expected that the number of access tracts and ancillary procedures used for complete stone clearance could negatively impact on renal function. Renal hypothermic ischemia is established, and a nephrotomy is made through the previously identified plane. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
Although parenchymal damage after anatrophic nephrolithotomy is of concern renal dysfunction is usually clinically insignificant.
Mean SD postoperative length of hospitalization was Thirteen patients underwent AN 0. Other authors also published their results regarding renal function. There was no perioperative mortality. Patients with staghorn calculi in a nonfunctioning kidney are candidates for nephrectomy, and the procedure also may be considered if the stone-laden kidney has irrevocably poor function providing the contralateral renal unit has satisfactory function. The clinical research office of the endourological society percutaneous nephrolithotomy global study: Support Center Support Center.
Comparison with contemporary AN series.
Usually there is an immediate decrease on renal function after surgery with return to baseline on long term. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases.
Discussion AN was designed to minimize renal parenchymal damage but few complications have been reported.
In the era of mininvasive treatments, laparotomy is rarely required, but it is important to recognize patients in whom open anatrophic nephrolithotomy could represent a valid choice of treatment [ 11 ].
November 17, Article in press: Kijvkai et al[ 18 ] compared standard ANL and modified ANL and concluded that the standard procedure preserved more renal function than the modified[ 18 ]. She had undergone laparotomic cholecystectomy and appendectomy 25 years previously and reported a previous left ESWL 8 years earlier.
The indications for AN in our patients were complex staghorn calculi involving pelvis and all calyces in 10 patients, massive stone burden with anatrohpic stenosis in two patients and failed PCNL in one patient. After injecting polyurethane in the pyelocaliceal system to create a staghorn calculus model the animals were submitted laparoscopic nephrolithotomy. El-Nahas et al [ 29 ]. An intraoperative blood transfusion was required.
Shen et al[ 47 ] also compared PNL and open surgery in a prospective randomized study. Ekelund et al [ 25 ]. Two CKD patients were on maintenance haemodialysis. A useful treatment option for complete complex staghorn calculi. With a mean follow-up of 6 years, patients with solitary kidneys operated on with classic ANL were evaluated by Stubbs et al[ 13 ] and associates. In particular older patients or affected by many comorbidities.
Urine culture at one month was positive for Klebsiella Pneumoniae and antibiotic therapy with Ceftriaxone was prescribed until complete remission, at 6 month and at one year after surgery were negative.
Long-term outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease: Posterior aspect of kidney was exposed after retroperitoneum was entered. OT — operation time; SWL — shock wave lithotripsy. Renal function was estimated by the Modification of Diet in Renal Disease study equation. Because of this probable bias, our observed rate of open surgery should not be interpreted as indicative of the general stone patient population, although it does allow for the examination of common indications for open surgery [ 11 ].
Evaluation of anatrophic nephrolithotomy under hypothermia. Open-Access Policy of This Article. Materials and Methods Between April and JulyAN was done in 14 renal units in 13 patients at our institute nephroithotomy is a tertiary care referral urological center.
Modified anatrophic nephrolithotomy for complete staghorn calculus disease — does it still have a place? There was no renal failure or new calculi during qnatrophic follow up period. However, the impact of those measures on renal function are not fully known. Comparative studies of the available modalities are scarce as well as long term follow-up and the impact of multiple procedures.
Surgical site infection was seen in 2 patients and urosepsis in 2 patients. Corresponding Author of This Article. Case Reports in Urology. Surgical site infection was seen in two patients xnatrophic Escherichia coli sensitive to nephrolithotomj and cefoperazone-sulbactam preoperative urine culture sterile and urosepsis in two patients, urinary tract infection in E.
Combination therapy in the treatment of patients with staghorn calculi.
Intravenous pyelogram and contrast enhanced computed tomogram were done in 12 out of 14 patients and the kidney showed good function in all patients. Median IQR clearance was 95 7. Anatrophic Nephrolithotomy AN is performed for complex staghorn stones which cannot be cleared by a reasonable number of Percutaneous Nephrolithotomy PNL attempts.
June 29, First decision: Abstract Introduction With advances in endourology, open stone surgery for staghorn calculi has markedly diminished. All patients had staghorn calculi occupying all calyces with largest stone measuring 6 cm. The aim of the procedure was to remove all calculi and fragments, improving urinary drainage, eradicating infections, and preserving renal function.