Indications for Open Stone Removal of Urinary Calculi

Abstract

In a retrospective study we analyzed patients undergoing open stone removal in the Department of Urology of the University of Tübingen. In 2.7% of all urinary calculi, open stone surgery was necessary. Open operation was performed on all patients with complete staghorn calculi as well as on patients with renal pelvic stones and simultaneous morphological obstruction. Partial staghorn calculi were operated on only after endoscopic treatment had failed. Small renal pelvic stones and ureteral stones were surgically removed only after extracorporeal shock wave lithotripsy (ESWL) and endoscopic surgery had been unsuccessful. The treatment of choice for ureteral calculi is ESWL. If ESWL is impossible, an endoscopic approach is advisable. Open operations of ureteral calculi only have to be performed if endoscopic therapy has failed or if there is a simultaneous morphological obstruction. Meta-analysis of publications from 1981 to 1995 confirmed our approach regarding indications for open stone removal. Comparison of the results reported in the literature is very difficult because of the missing, but generally accepted definition of stone free. In addition different examination techniques to determine the status Ê»stone free’ make it difficult to compare the various studies.

Radiological Investigations, Biochemical Renal Function Tests and the Changes After Surgery in Renal Calculus Obstructive Uropathy

“…8,9 The definitive treatment of the stone should be delayed until sepsis is resolved, which includes endourology techniques like Percutaneous Nephrolitholapaxy (PCNL), Ureterorenoscopy (URS), open and laparoscopic surgery, Extracorporeal Shock Wave Lithotripsy (ESWL). [10][11][12] In our study we plan to evaluate the radiological and biochemical improvement in the renal function of patients who have undergone surgery for renal stones causing obstruction.…”

Have the Technological Advancements Changed the Distribution of Treatment Modalities for Urolithiasis?

“…4 In 1997, demonstrating the practice patterns in Europe, Bichler and his co-workers from Tubingen performed open surgery in 2.7% of the cases, and PCNL in 22% of the cases. 10 In a study dealing with the actual basic management alternatives of kidney stones in our country, the representatives of the Ministry of Health reported that, of 13 347 procedures performed in 2008, 39.1% of the cases were managed by open surgery and the remaining 60.9 % of the cases were managed by PCNL. 11 Of those surgical interventions, 50 154 were performed in university hospitals, 3239 were managed in state training and research hospitals, 2661 in private hospitals and lastly 2433 were performed in state hospitals.…”

“…Open surgery is nowadays rarely reported in papers published from developed countries. 4,9,10 Instead of highly invasive open surgical approach, a less invasive laparoscopic approach with successful outcomes became the first alternative especially in large and impacted ureteral calculi where SWL and URS had been unsuccessful. In a recently published study from Iran, the authors compared the efficacy of retrograde URS, laparoscopic ureterolit-hotomy and percutaneous antegrade approach in proximal ureteral calculi larger than 1.5 cm, and found similar efficacy rates where only 2 cases required open surgery for stone removal.…”

Diagnostik und Therapie der Urolithiasis — Tübinger Konzept

“…Bei guten Ergebnissen muû sich dieses invasive Verfahren an der weniger invasiven extracorporalen Stoûwellenlithotripsie (ESWL) und dem zweiten Gegenpol, der offenen Steinsanierung messen lassen [12].…”