The outcome of open renal stone surgery calls for limitation of its use: A single institution experience

Abstract

Objectives: To critically analyze retrospectively the outcome of cases treated with open renal stone surgery (ORSS) at a single urology institution over a 7-year period. Subjects and methods: Out of 5172 stone-removal procedures performed at Al-Azhar University Hospitals, Cairo, Egypt, between January 2002 and December 2008, 533 cases (10.3%) underwent open surgery. The patients’ age ranged from 3 to 72 years (mean 41.7). The hospital charts, operative notes and pertinent radiographs of these 533 cases were revised to determine clinical data, stone burden, indications and operative and peri-operative outcome of surgery. The follow-up data covering a period of two years since the date of surgery were retrieved to study long-term results. Results: The indications for ORSS included complex stone burden (62.1%), failure of percutaneous nephrolithotomy (10.3%), large or multiple stones associated with calyceal diverticulum, ureteropelvic obstruction (5.8%) or ectopic and horse-shoe kidneys (3.4%). Additional indications were an abnormal body habitus, including an increased body mass index (BMI > 35), and scoliosis (3.4%), concurrent open surgery (4.1%), and stones in non-functioning or infected kidneys (5%). 5.8% of the patients refused minimally invasive surgery and opted for ORSS. Operative complications, mainly in the form of primary or secondary hemorrhage, occurred in 186 (35%) patients. Salvage nephrectomy (secondary nephrectomy) was needed in two cases and mortality occurred in another two.

Keywords: Renal stones; Open renal stone surgery (ORSS); Urolithiasis

African Journal of Urology (2013) 19, 58–65