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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November 17, Article in press: Review on renal recovery after anatrophic nephrolithotomy: Patient comorbidities, direct injury by kidney puncture and tract dilation, ischemia, inflammation and fibrosis are some of the possible mechanisms implicated on anqtrophic function deterioration.

Retroperitoneal drain and double J stent were placed in all 13 patients. The mean SD in situ cold ischemia time was Introduction Staghorn calculi cause severe morbidity due to renal failure; infections and death [ 1 ]. Zhou L et al.

Ureter was then looped and dissection anatro;hic hilum was done to identify renal artery, vein and then the posterior segmental artery. Intraoperative images depicting stages of anatrophic nephrolithotomy; a Posterior segmental artery clamped and sterile crushed normal saline ice slush nephrolihhotomy around kidney and covered for 15 minutes; b Calyx incised and adjacent infundibula opened; c Calicoplasty with polydiaxonone sutures; d Double J stent placement in renal pelvis; e Nephrostomy placement and renal pelvis closure.

The effects of percutaneous nephrolithotomy on renal function in geriatric patients in the early postoperative period. The advent of laparoscopic stone removing procedures has further reduced the need to aantrophic open surgery, even anatrophic nephrolithotomy [ 3 — 10 ]. A year-old morbidly obese female patient complaining about occasional left flank pain, and recurrent cystitis for many years, presented bilateral staghorn kidney stones.


Median IQR estimated blood loss was 75 ml. When functional markers are employed, kidney damage is temporary and usually mild.

Eighty-eight renal units were assed, 43 submitted to PNL and 45 to conventional surgery. Table of Contents Alerts. 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. Belis et al [ 15 ].

Ancillary procedures such as extracorporeal shock wave lithotripsy ESWL and retrograde intrarenal surgery RIRS are frequently required for complete clearance of staghorn stones.

Indication to Open Anatrophic Nephrolithotomy in the Twenty-First Century: A Case Report

The main renal artery and vein were then occluded with bulldog clamps. It is essential to carefully select the patient for this treatment, frequently they may prefer a single procedure avoiding the risk of a repeated PNL [ 16 ].

AN was performed for complex staghorn calculi involving nelhrolithotomy and all calyces in 10 patients, infundibular stenosis in two patients and failed PNL in one patient. The renal function was unaffected based on preoperative and postoperative serum creatinine levels. 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 ].

A year-old female patient with ajatrophic BMI of 36,2 was referred nephrolithotomh General Medicine Department with a diagnosis of bilateral staghorn kidney stone, documented by an abdominal X-ray Figure 1. Morbidity related to intraoperative and postoperative complications is one of them.

In this review we assess functional results after anatrophic nephrolithotomy. King et al[ 24 ] evaluated seven consecutive patients submitted to RANL. The anatrophic plane is defined by occluding the posterior segmental artery and administering methylene blue intravenously. All nephrooithotomy had staghorn calculi occupying all calyces with largest stone measuring 6 cm.


Shen et al[ 47 ] also compared PNL and open surgery in a prospective randomized study. Renal hypothermic ischemia is established, and a nephrotomy is made through the previously identified plane.

Anatrophic nephrolithotomy.

Combination therapy for staghorn calculi in solitary kidneys: Morbidly obese patients may require this approach as their body habitus precludes fluoroscopic imaging and endoscopic manoeuvring required for PNL. Laparoscopic nephrectomy is an option, but open surgical nephrectomy may be a safer approach if there is intense perirenal inflammation, such as that which occurs with chronic xanthogranulomatous pyelonephritis [ 21 — 24 ].

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Combined minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for staghorn calculi in patients with solitary kidney. Tree patients were submitted to preoperative 99mTc-DTPA renography nephrolithotoky asses renal function 3 mo after surgery. Nevertheless, information about long term follow-up is scarce, as well as the the cumulative impact of multiple procedures.

After induction, Foley cathetrisation was done in supine position. Stent removal was done in all patients between weeks.

There was no renal failure or new calculi during the follow up period. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. The collecting system was opened and the stones were nephrolithotoomy. One patient underwent ipsilateral PNL four years back, one patient came for clearance post PNL and one patient underwent pyelolithotomy 7 years back.