Current Indications for Open Stone Surgery in the Treatment of Renal and Ureteral Calculi after Introduction of ESWL

Jung, Jin Won; Rha, Koon Ho; Lee, Moo Sang

Abstract

PURPOSE
The developments and advances in extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open surgery in the treatment of renal and ureteral stones. We reviewed our experience of open stone surgery to determine current indications and efficacy of this treatment modality.
MATERIALS AND METHODS
We undertook a review of hospital and office charts, operative records, and pertinent radiographic studies of all patients that had undergone open stone surgery from May 1986 to June 2001 at a single tertiary university hospital. Of 5,533 procedures performed for stone removal, 355 were open surgical procedures (6.4%), these included ureterolithotomy in 215 (60.6%), pyelolithotomy in 50 (14.1%), anatrophic nephrolithotomy in 43 (12.1%), and nephrectomy in 47 (13.2%).
RESULTS
The indications for open surgery were complex stone burden (61%), failure of extracorporeal shock wave lithotripsy or endourological treatment (9%), other co- operation (10.4%) and anatomical abnormalities, such as: ureteropelvic junction obstruction, infundibular stenosis and/or renal caliceal diverticulum (6.5%). Stone free rate, following surgery, was 90.7%. All patients had minor postoperative complications that were resolved with appropriate therapy.
CONCLUSIONS
Open stone surgery continues to be a reasonable alternative modality for a small proportion of patients with urinary stones. Those patients with large urinary stone, failed less invasive method, anatomical abnormality and serious medical diseases would be recommended for open stone surgical correction.