 |
|
|
|
|
 |
|
| |
KIDNEY STONES SURGERY
Category: Urology
Abstract : Kidney stones: open stone surgery Indications - Complex stone burden
(projection of stone into multiple calyces, such that multiple PCNL tracks would
be required to gain access to all the stone) - Failure of endoscopic
treatment (technical difficulty gaining access to the collecting system of the
kidney) - Anatomic abnormality that precludes endoscopic surgery (e.g.
retrorena
Kidney stones: open stone surgery
Indications
- Complex stone burden
(projection of stone into multiple calyces, such that multiple PCNL tracks would
be required to gain access to all the stone)
- Failure of endoscopic
treatment (technical difficulty gaining access to the collecting system of the
kidney)
- Anatomic abnormality that precludes endoscopic surgery (e.g.
retrorenal colon)
- Body habitus that precludes endoscopic surgery (e.g.
gross obesity, kyphoscoliosis open stone surgery can be difficult)
- Patient
request for a single procedure where multiple PCNLs might be required for stone
clearance
- Non-functioning kidney
Non-functioning kidney
Where the
kidney is not working, the stone may be left in situ if it is not causing
symptoms (e.g. pain, recurrent urinary infection, haematuria). However, staghorn
calculi should be removed, unless the patient has comorbidity that would
preclude safe surgery because of the substantial risk of developing serious
infective complications. If the kidney is non-functioning, the simplest way of
removing the stone is to remove the kidney.
Functioning kidneys options
for stone removal
Small- to medium-sized stones
- Pyelolithotomy
-
Radial nephrolithotomy
Staghorn calculi
- Anatrophic (avascular)
nephrolithotomy
- Extended pyelolithotomy with radial nephrotomies (small
incisions over individual stones)
- Excision of the kidney, bench
surgery to remove the stones, and autotransplantation
Specific
complications of open stone surgery
Wound infection (the stones operated on
are often infection stones); flank hernia; wound pain. (With PCNL these problems
do not occur, blood transfusion rate is lower, analgesic requirement is less,
mobilization is more rapid and discharge earlier all of which account for PCNL
having replaced open surgery as the mainstay of treatment of large stones.)
There is a significant chance of stone recurrence after open stone surgery (as
for any other treatment modality) and the scar tissue that develops around the
kidney will make subsequent open stone surgery technically more difficult.
Hit: 381 times
Related Articles in Urology :
|
| |
|
|
|
|
|
Advertise with Health Information Encyclopedia