Role of open surgery in the management of staghorn calculus
Keywords:Kidney Calculi. Nephrostomy, Percutaneous. Lithotripsy. Kidney Calices. Ureteral Calculi. Ureteroscopy. Physical Therapy Modalities. Urinary Bladder Calculi. Kidney Pelvis.
Objective: To evaluate the role of open surgery in the management of staghorn calculi by comparing it with other available modalities of treatment i.e. percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) and assessing improvement in the renal function (parenchymal thickness & glomerular filteration rate (GFR) after stone removal. Design: Institutional- based prospective study. Place and Duration of study: This study was conducted at the department of Urology, Nishter hospital, Multan from January 2000 to February 2002 (2 years). Subjects & Methods: A total of fifty patients with staghorn calculi who underwent open surgery in the department & completed a three-month follow-up were included in the study. All patients had a complete blood examination (CBE), complete urine examination (CUE) (including culture & sensitivity (CIS), renal parameters (urea & creatinine), renal tract ultrasonography (USG) preoperatively & at first, second & third month of follow-up to assess the improvement in heamoglobin, control of urinary tract infection (UTI), parenchymal thickness & postoperative complications. Tc99m DTPA scan was employed before surgery & at third month of follow-up to evaluate the improvement in GFR for operated kidney. Results: The male to female ratio was 2.1:1, with a mean age of presentation of 42.70 years. Pain in the lumbar region (58%) was the most common presentation followed by lower urinary tract symptoms (LUTS 32%) & renal insufficiency (16%). Fever (36%) was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. It fell to 10.21 gm at first month of follow-up but increased to 11.89 gm by the third month. . The mean GFR before surgery was 77.18ml/min, which increased to 81.56ml/min after surgery at third month of follow-up. The mean GFR of the kidney with stones was 32.46 ml/min before surgery, which increased to 39.84-ml/ min after surgery. Conclusion: Staghorn stones if left untreated lead to chronic UTI & renal insufficiency. Removal of the stone is the only way these consequences can be avoided. Nonavailability of resources, a poor health care system, the lack of PCNL & ESWL facilities &/or expertise, the cost & need for multiple sessions &/or ancillary procedures in these minimally invasive techniques & the vigorous follow-up required still make open surgery a viable & an applicable option in our socioeconomic setup.
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