FUNCTIONAL OUTCOME OF SURGERY FOR STAGHORN CALCULI
Hesham Mohamed Fathi;
Abstract
Staghom stones represents a therapeutic challenge to urologists. Treatment options include ESWL monotherapy, PCNL, PCNL and ESWL, and open surgery. Open surgery can be used for giant staghom stones in cases not expected to be removed by reasonable number of endoscopic procedures or in cases like (morbid obesity, skeletal deformities).
We tried to study both anatrophic nephrolithotomy and multiple nephrotomies as techniques for open surgery used for staghom stones.
Forty five cases with large staghom stones were included in this study. They were divided into two groups,
First groups including 20 cases who were managed by anatrophic nephrolithotomy,
Second group containing 25 cases who were managed by pyelolithotomy with multiple nephrotomies.
Age ranged between 9 years and 75 years with mean of 44.9 ± 16.4 years, preoperative GFR ranged between 10 ml/min and 95 ml/min with mean of 40.25
± 18.8 mllmin. Follow-up range between 3 and 60 months and mean 9.4 ± 11.3.
Twelve patients (80%) were completely free from stones post operatively and at follow-up, 3 patients (20%) showed post-operative residuals with two of them (13.3%) with small <4 mm, peripheral stones requiring no further intervention. Ischaemia time ranged between 30 minutes and 90 minutes with
mean of 66 ± 17.4 minutes. GFR as measured by radioisotope studies showed
almost no change between pre-operative mean 39.42 ml/min and at 3 months
follow-up 39.43 ml/min with P-value 0.997. Serum creatinine also shows minimal drop between pre-operative mean 1.8927 mg/dl and at three months follows-up after surgery (mean 1.8667 mg/dl) with P-value 0.801.
Both techniques proved to be effective and give comparable results as regarding operative time, residual stones, need for blood transfusion, dialysis postoperatively, pleural injury and effect on kidney functions.
We are in need of new classification system for staghom stones which takes into consideration stone volume and mode of treatment to unify treatment modalities for each subgroup, and results between different centers.
We tried to study both anatrophic nephrolithotomy and multiple nephrotomies as techniques for open surgery used for staghom stones.
Forty five cases with large staghom stones were included in this study. They were divided into two groups,
First groups including 20 cases who were managed by anatrophic nephrolithotomy,
Second group containing 25 cases who were managed by pyelolithotomy with multiple nephrotomies.
Age ranged between 9 years and 75 years with mean of 44.9 ± 16.4 years, preoperative GFR ranged between 10 ml/min and 95 ml/min with mean of 40.25
± 18.8 mllmin. Follow-up range between 3 and 60 months and mean 9.4 ± 11.3.
Twelve patients (80%) were completely free from stones post operatively and at follow-up, 3 patients (20%) showed post-operative residuals with two of them (13.3%) with small <4 mm, peripheral stones requiring no further intervention. Ischaemia time ranged between 30 minutes and 90 minutes with
mean of 66 ± 17.4 minutes. GFR as measured by radioisotope studies showed
almost no change between pre-operative mean 39.42 ml/min and at 3 months
follow-up 39.43 ml/min with P-value 0.997. Serum creatinine also shows minimal drop between pre-operative mean 1.8927 mg/dl and at three months follows-up after surgery (mean 1.8667 mg/dl) with P-value 0.801.
Both techniques proved to be effective and give comparable results as regarding operative time, residual stones, need for blood transfusion, dialysis postoperatively, pleural injury and effect on kidney functions.
We are in need of new classification system for staghom stones which takes into consideration stone volume and mode of treatment to unify treatment modalities for each subgroup, and results between different centers.
Other data
| Title | FUNCTIONAL OUTCOME OF SURGERY FOR STAGHORN CALCULI | Other Titles | النتائج الوظيفية لاستخدام الجراحة لحصوات الكلى المتشعبة | Authors | Hesham Mohamed Fathi | Issue Date | 2006 |
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