CURRENT INDICATIONS FOR OPEN STONE SURGERY IN THE TREATMENT OF RENAL AND URETERAL CALCULI

Purpose: The development and advances in extracorporeal shock wave lit hotripsy and endourological procedures have greatly diminished the nee d for open surgery in the treatment of renal and ureteral stones. We r eviewed our experience with open stone surgery to determine the curren t indications and efficacy of this treatment modality. Materials and M ethods: Hospital and office charts, operative notes and records, and p ertinent radiographic studies of all patients undergoing open stone su rgery from January 1991 through December 1995 at 3 university affiliat ed hospitals were reviewed. Patient characteristics, stone burden, ind ications, surgical factors and outcomes were reviewed for each patient . Results: Of 780 procedures performed for stone removal, 42 were open surgical procedures (5.4%) including pyelolithotomy in 15 (extended p yelolithotomy or pyelonephrolithotomy in 7), anatrophic nephrolithotom y in 14, ureterolithotomy in 7 and radial nephrolithotomy in 6. There were 24 men and 18 women ranging in age from 1 to 90 years (mean age 5 1.5). The most common indications for open surgery were complex stone burden (55%); failure of extracorporeal shock wave lithotripsy or endo urological treatment (29%); anatomic abnormalities such as ureteropelv ic junction obstruction, infundibular stenosis and/or renal caliceal d iverticulum (24%); morbid obesity (10%) and co-morbid medical disease (7%). Mean estimated blood loss was 428 cc. Average hospital stay was 6.4 days. The stone-free rate after surgery was 93%. Five patients had minor postoperative complications that resolved with appropriate ther apy. Conclusions: While most patients with renal and ureteral stones c an be treated with less invasive techniques, open stone surgery contin ues to represent a reasonable alternative for a small segment of the u rinary stone population.