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. Peri-operative (at 3 months) outcome, included significant residual fragments in 59 cases (11%) and deterioration of renal function in 92 (17.3%) cases. At discharge from the hospital, 76.2% of the patients were stone-free, while complete stone clearance was attained in a total of 89.1% at 3 months after additional auxiliary measures. Conclusions: Although nowadays, the treatment of choice for renal stones is minimally invasive, yet some cases still require open surgery. The high rate of surgical complications with ensuing compromised renal function and prolonged hospital stay are not in favor of ORSS. This option thus has to be limited to selected cases of complex stone burden, associated renal anomalies and after failure of minimally invasive surgery. The unavailability of minimally invasive equipment, lack of surgical experience and patient preference should not be taken as indication of ORSS.

Keywords

• Renal stones
• Open renal stone surgery (ORSS)
• Urolithiasis