Surgical treatment of staghorn calculi

Abstract

Introduction: Urinary stones occur at any age but affects mainly people of reproductive age: in 70% occur in patients of 20-50 years. Staghorn stones are detected more frequently in women (up to 70%).Staghorn kidney stones occur in 17-40% of all patients with nephrolithiasis and in 6-7% of cases among patients of urological profile. There are many ways to treat staghorn calculi, but open surgery remains the first choice, where are presented large stones, multiple stones and infected ones. The aim of the study: The aim is to improve results of surgical treatment of patients with staghorn calculi, highlighting the methods and concepts of contemporary surgical treatment of nephrolithiasis. Scientific Significance. Open surgical treatment of staghorn nephrolithiasis remains a milestone in the treatment of nephrolithiasis. Being an invasive treatment, it is well tolerated by patients with the large stones, complicated and infected one with the failures of other existing methods. Work Tasks: 1.Study of the pathogeny in staghorn nephrolithiasis. 2. Study of the existing methods and types of surgical treatment of staghorn calculi. 3. Examination of the own results in the study of patients with staghorn calculi. Material and methods: The study was conducted between the years 2009 - 2011, the urology clinic of Clinical Hospital, there were 13 patients with staghorn nephrolithiasis performing nephrolithotomies. Age of patients ranged from 23 to 73 years, average age was 46.13 years. The study group allocation of patients according to sex was 4 (33.3%) males and 9(66.7%)-women. Roentghen-negative stones was 1 (7.7%) and X-ray-positive patients 12 (92.3%). According to kidney damage, have been assigned: Right 4 (30.7%), the left seven (53.8%), bilateral 2 patients (15.3%). The relative sizes of the stones ranged from 3 to 7 cm, with an average of 3.44 ± 0.9 cm. Multiple stones were present in 3 (20.3%) patients and unique 10 (77%). In all patients undergoing surgery of staghorn nephrolithiasis was present chronic pyelonephritis on the affected side, the phase of overheating - 2 (15.3%) in remission - 3 (23.0%), the latent phase - 8(61.7 %) cases. The group of patients described above underwent surgery: the anatrofk nephrolithotomy with refrigeration in 1 (7.7%) cases, the pielonephrolithotomy in 5 (38.5%) cases, radial nephrolithotomy with clamping the vascular foot in 3 (23.0%) cases, calicolithotomy - in 1 (7.7%) cases and nephrolithotomy without vascular clamping in 3 (23.0%). Clamping the renal artery with kidney refrigeration was used in 1 (7.7%) cases. Clamping the vascular foot (artery + vein) - 3 (23.0%) cases. Conclusions: With bleeding and trauma and at the same time radical surgical methods remains the basic treatment of Staghorn Nephrolithiasis. Setting correct indications and patient selection based on pre-and intraoperative data storage, nephrolithotomy cause results are optimal for treatment of severe and complicated staghorn nephrolithiasis. Classical surgery is currently a backup method, useful in complex cases where less aggressive alternative therapies have failed or could not be used.