The (Soon Forgotten) Art of Open Stone Surgery: To Train or Not To Train?

Abstract

To date, open stone surgery is now performed in a very limited number of selected cases. A review of our own cases revealed that open surgery constituted 1% of all procedures. These procedures were mostly ablative, or operations to deal with complications of failed minimally invasive therapies. Given two continuing trends towards sub-specialisation in urology on the one hand, and minimally invasive therapy on the other, the question arises whether and how sub-specialised stone surgeons should and can learn open stone surgery. Is it merely a lost art not to be bothered with, or is it something worthwhile preserving? This article discusses the pros and cons of the argument and suggests centralisation of complex stone cases as a possible way out of the dilemma.

Does Open Stone Surgery Still Play a Role in the Treatment of Urolithiasis? Data of a Primary Urolithiasis Center

“…[2][3][4][5][6][7][8][9] Complex stone disease, defined as stone burden involving the entire collecting system or all of the renal pelvis and a majority of the calices, was the most common indication for open stone surgery, occurring in 42% of patients. This number is comparable to other groups like Paik and Resnick, who reported complex stone burden as indication for open surgery in 55% of their patients.…”

Upper Urinary Tract Calculi in Senegal: A Comparative Study between Open Surgery and Endoscopy, a Review of 89 Cases

“…Open surgery generally represents only 1% -5% of surgical treatment of upper urinary tract calculi in Europe [4]. Semi-rigiduréteroscopy 33 15…”

Outcomes of Percutaneous Nephrolithotomy Versus Open Stone Surgery for Pateints with Staghorn Calculi Safety and Efficacy

“…8,9,10,11,12,13 In UK the frequency of OSS was 1%. 14 In developing countries, like in China, that rate of OSS is increased to 7.4% in their series. 15 In Pakistan, the reported rate of OSS in pediatrics is about 70%.…”