Name of the Procedure:

Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

Summary

A nephrolithotomy is a surgical procedure to remove a large kidney stone, known as a staghorn calculus, from the kidney's pelvis and calyces. This procedure often includes an anatrophic pyelolithotomy, which is a specific type of incision to access and remove the stone.

Purpose

This procedure is performed to address the presence of a large staghorn calculus that can cause obstruction, pain, infections, or kidney damage. The goal is to completely remove the stone to restore normal kidney function and alleviate symptoms.

Indications

• Presence of a large staghorn calculus confirmed through imaging
• Persistent pain and discomfort despite other treatments
• Frequent urinary tract infections or hematuria (blood in urine)
• Impaired kidney function or risk of kidney damage

Preparation

• Fasting for at least 6-8 hours prior to the procedure
• Adjustment or discontinuation of certain medications as advised by the doctor
• Preoperative imaging tests such as CT scans or ultrasounds to locate the stone
• Blood tests and urine analysis to assess overall health and kidney function

Procedure Description

1. The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. A small incision is made in the patient's back to access the kidney.
3. Using specialized instruments, the surgeon locates and isolates the staghorn calculus.
4. An anatrophic pyelolithotomy incision is made to allow for the complete removal of the stone.
5. All stone fragments are carefully extracted, and the area is inspected to ensure no residual fragments remain.
6. A drainage tube may be placed to help with post-operative healing and fluid drainage.
7. The incision is closed, and dressings are applied.

Duration

The procedure typically takes 3 to 4 hours, depending on the size and complexity of the kidney stone.

Setting

Nephrolithotomy is performed in a hospital operating room or a specialized surgical center.

Personnel

• Urologist or a surgeon specializing in kidney surgeries
• Anesthesiologist
• Surgical nurses and technicians
• Radiologist (if imaging is needed during surgery)

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or tissues
• Prolonged pain or discomfort
• Incomplete removal of the stone requiring further treatment
• Rare risks include kidney damage or failure

Benefits

• Complete removal of the staghorn calculus
• Relief from pain and discomfort
• Prevention of further kidney damage and improvement in kidney function
• Reduction in the frequency of urinary tract infections

Recovery

• Hospital stay of 2 to 4 days post-procedure
• Pain management with prescribed medications
• Instructions on wound care and activity restrictions
• Follow-up appointments to monitor recovery and kidney function
• Full recovery can take 4 to 6 weeks, with gradual resumption of normal activities

Alternatives

• Extracorporeal Shock Wave Lithotripsy (ESWL): Non-surgical option but may be less effective for large stones
• Ureteroscopy: Minimally invasive but may require multiple sessions for complete stone removal
• Percutaneous Nephrolithotomy (PCNL): Less invasive but may not be suitable for very large stones

Pros and Cons of Alternatives

ESWL:

• Pros: Non-invasive, shorter recovery time
• Cons: May not completely remove large stones, multiple treatments needed

Ureteroscopy:

• Pros: Minimally invasive, shorter recovery
• Cons: Less effective for large or complex stones, may require multiple procedures

PCNL:

• Pros: Effective for moderately large stones, shorter recovery than open surgery
• Cons: Still invasive, less suitable for very large stones

Patient Experience

• General anesthesia ensures the patient feels no pain during the procedure
• Post-operative pain can be managed with medications
• Discomfort at the incision site and some mobility restrictions are expected during recovery
• Follow-up care and regular monitoring are essential to ensure complete healing and kidney function restoration