Pipal DK. et al. 2023: A huge staghorn renal stone: Is there still a need for open surgery to protect against further damage to the kidney? A case report.
Pipal DK, Jain S, Biswas P.
Department of General Surgery, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India ORCID iD: https://orcid.org/0000-0002-4162-86
Arihant Hospital, Bhilwara, Rajasthan, India.
Abstract
Introduction: Staghorn calculi (SC) occupy the renal pelvis and calyces and are common in females linked to repeated urinary tract infections (UTIs). Judicious surgery planning reduces the chance of further damage to the kidney due to renal SCs. Open stone surgery (OSS) is one of the various operative techniques to remove such huge stones with one operative intervention and protect the kidney from ongoing functional damage.
Case report: A 47-year-old male patient presented with right-sided renal colic pain, and on further investigations, he was diagnosed with a large renal stone responsible for substantial renal function impairment on the same side. The SC measured 8 × 4 cm with another stone in the lower calyx. thinner parenchyma, and only 16% relative function. Therefore, open surgery was selected over less invasive approaches because multiple lithotripsy (ESWL) sittings may have been required in less invasive options.
Discussion: SCs, which can be complete or partial, often result in renal impairment. Hence, it is crucial to implement a proactive therapeutic approach that includes a thorough evaluation of the stone's size and position, the patient's choice, and institutional capacity. Complete elimination of SCs is preferred to maintain maximal renal function. Based on clinical, technical, and socioeconomic considerations, open pyelolithotomy or OSS was chosen over percutaneous nephrolithotomy for SC removal in the discussed case.
Conclusion: The ability to remove large stones in a single intervention with open pyelolithotomy has been very effective due to its distinctive clinical presentation and pathological abnormalities.
Qatar Med J. 2023 Oct 25;2023(4):30. doi: 10.5339/qmj.2023.30. eCollection 2023. PMID: 37885907 FREE PMC ARTICLE
Comments 1
”In the resource-limited setting or the centers where minimal invasive technique is not available or if present but not easily affordable by the patients, an open pyelolithotomy is still an impervious approach ...” YES, however, this is a very special, easy case of a staghorn stone. A normal serum creatinine that is maintained by a normal contralateral kidney. A stone baring kidney that probably has ved and the majority of the stone volume was in peripheral calyces.
”Therefore, the OSS should continue to be taught to medical students and put into practice whenever necessary because it still applies to modern urological practice.” YES, if the case is easy like this, however surgery for the true complex cases is not taught any more because there are no epxerienced teachers any more.
Peter Alken