Introduction. Anatrophic nephrolithotomy is a procedure in which a parenchymal incision is made in an intersegmental plane, allowing removal of large renal. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was minutes. Blood loss was cc. requiring one. The anatrophic nephrolithotomy described by Smith and Boyce is an excellent method of preserving a maximum number of functioning nephrons by minimizing .

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For these reasons the patient was scheduled for staged open bilateral anatrophic nephrolithotomy, and we elected to treat the side with the lower stone burden first. Article-Type of This Article. Right ratio was 9: To receive news and publication updates for Case Reports in Urology, enter your email address in the box below.

Floseal was applied on the suture line Figure 5. June 27, Peer-review started: During the hospitalization, an abdominal CT scan was performed and confirmed the presence of bilateral sthagorn stones Figures 2 nephrilithotomy 3. Relationship between kidney size, renal injury, and renal impairment induced by shock wave lithotripsy.

In expert hands, anatrophic nephrolithotomy is an effective procedure, which spares renal function. Anatrophic nephrolithotomy ANL is one of the most used option for conventional staghorn calculus removal. Patients with ndphrolithotomy calculi in a nonfunctioning kidney are candidates for nephrectomy, and the procedure also may be considered if the stone-laden kidney has irrevocably poor function providing the contralateral renal unit has satisfactory function.

In these anatfophic cases open surgery may be performed with high stone-free rate and very low morbidity. Between April and JulyAN was done in 14 renal units in 13 patients at our institute which is a tertiary care referral urological center. One patient underwent ipsilateral PNL four years back, one patient came for clearance post PNL and one patient underwent pyelolithotomy 7 years back.

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Anstrophic the advances in laparoscopic and robotic assisted methods replication of the open technique is possible with less morbidity.

Case details of patients undergoing AN were retrieved from our institutional patient database. All patients were operated under general anaesthesia.

Case Reports in Urology

Shen et al[ 47 ] also compared PNL and open surgery in a prospective randomized study. Publishing Process of This Article. Standard Multilenght stent was placed in the ureter, and a Malecot tube was left in pelvis.

J Med Assoc Thai. Undoubtedly, the main reason for conventional surgery rates decrease is the improvement of techniques such as extracorporeal shockwave lithotripsy SWL and endourological procedures ureteroscopy and PNL [ 6 – 9 ]. Find articles by Ananth Janarthan Kamath.

Indication to Open Anatrophic Nephrolithotomy in the Twenty-First Century: A Case Report

Blunt separation of parenchyma was done along the plane with back of Bard Parker knife handle. A laparoscopic approach was not indicated because of the severe long standing COPD and previous open abdominal operations. Zeng et al[ 43 ] reported that only 2.

Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi: Staghorn calculi were completely removed Figure 4 and the absence of stones was evidenced with intraoperative fluoroscopy.

The anatrophic plane is defined by occluding the posterior segmental artery and administering methylene blue intravenously. Endocrinol Metab Clin Anatrophiic Am. The advent of laparoscopic stone removing procedures has further reduced the need to perform open surgery, even anatrophic nephrolithotomy [ 3 — 10 ].


Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Belis et al [ 15 ]. Han SH et al. Anatrophic nephrolithotomy in the management of large staghorn renal calculi.

When functional markers are employed, kidney damage is temporary and usually mild. A year-old female patient with a BMI of 36,2 was referred from General Medicine Department with a diagnosis of bilateral staghorn kidney stone, documented by an abdominal X-ray Figure 1. Morey AF et al.

Anatrophic nephrolithotomy.

A flank incision is made and the kidney carefully mobilized. Open surgery can represent a valid alterative in the nephrolitjotomy of ajatrophic kidney stones of very selected cases. Renal hypothermic ischemia is established, and a nephrotomy is made through the previously identified plane. Retroperitoneal drain and double J stent were placed in all 13 patients. Improvement or stabilization of renal function may occur because of better drainage, infection and inflammation resolution after surgery.

The duration of symptoms was Results AN was performed for complex staghorn calculi involving pelvis and all calyces in 10 patients, infundibular stenosis in two patients and failed PNL in one patient.