, Volume 47, Issue 4, pp 365–370 | Cite as

Long-term effects of anatrophic nephrolithotomy on selective renal function

  • Ahmed R. EL-NahasEmail author
  • Amr A. Elsawy
  • Ahmed Abdelhalim
  • Mohamed M. Elsaadany
  • Yasser Osman
Original Paper


To evaluate the long-term changes of selective renal function after anatrophic nephrolithotomy (ANL). A retrospective study was conducted for patients who underwent ANL between January 1995 and December 2016. Inclusion criteria were availability of preoperative and follow-up (1 year or more) radio-isotopic renal scans. Stone-free status was evaluated after 1 month with KUB and ultrasonography or NCCT. Renal isotope scans using 99mTc MAG3 were performed to measure the changes in selective function of the affected kidney (GFR%). Eligible patients were classified into two groups, group 1 patients with stable or improved function and group 2 patients with deteriorated function (> 5% decrease in GFR%). Univariate and multivariate analyses were performed to determine risk factors for deterioration of renal function. The cutoff value for any significant variable was determined using ROC curve. The study included 50 patients with mean age 43.8 + 13.9 years. Complications developed in 26 patients (52%), and stone-free status was documented in 42 patients (84%). After a median follow-up of 2.7 years (range 1–11), mean GFR% of all cases significantly decreased from preoperative value of 52.7% + SD 20 to 45.4% + SD 25% during follow-up (P < 0.001). Deterioration of GFR% was documented in 21 kidneys (42%). Cold ischemia time with a cutoff value 50 min was the independent risk factor (RR 3.986, 95% CI 1.069–14.869, P 0.039). The results of this study support limiting ANL to a selected group of patients and taking all the possible efforts to minimize cold ischemia time below 50 min.


Staghorn Anatrophic PCNL Long-term GFR 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS (2005) Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 173:1991–2000CrossRefGoogle Scholar
  2. 2.
    Smith MJV, Boyce WH (1968) Anatrophic nephrotomy and plastic calyrhaphy. J Urol 99:521–527CrossRefGoogle Scholar
  3. 3.
    Clayman RV, Surya V, Miller RP et al (1983) Percutaneous nephrolithotomy; an approach to branched and staghorn renal calculi. JAMA 250:73–75CrossRefGoogle Scholar
  4. 4.
    Mishra S, Sabnis RB, Desai M (2012) Staghorn morphometry: a new tool for clinical classification and prediction model for percutaneous nephrolithotomy monotherapy. J Endourol 26:6–14CrossRefGoogle Scholar
  5. 5.
    Kukreja R, Desai M, Patel S et al (2004) Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 18:715–722CrossRefGoogle Scholar
  6. 6.
    El-Nahas AR, Eraky I, Shokeir AA, Shoma AM et al (2012) Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. Arab J Urol 10:324–329CrossRefGoogle Scholar
  7. 7.
    Fayad AS, Elsheikh MG, Mosharafa A et al (2014) Effect of multiple access tracts during percutaneous nephrolithotomy on renal function: evaluation of risk factors for renal function deterioration. J Endourol 28:775–779CrossRefGoogle Scholar
  8. 8.
    El-Husseiny T, Buchholz N (2012) The role of open stone surgery. Arab J Urol 10:284–288CrossRefGoogle Scholar
  9. 9.
    Simforoosh N, Aminsharifi A, Tabibi A et al (2008) Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi. BJU Int 101:1293–1296CrossRefGoogle Scholar
  10. 10.
    King SA, Klaassen Z, Madi R (2014) Robot-assisted anatrophic nephrolithotomy: description of technique and early results. J Endourol 28:325–329CrossRefGoogle Scholar
  11. 11.
    Belis JA, Morabito RA, Kandzari SJ, Lai JC, Gabriele OF (1981) Anatrophic nephrolithotomy: preservation of renal function demonstrated by differential quantitative radionuclide renal scans. J Urol 125:761–764CrossRefGoogle Scholar
  12. 12.
    Thomas R, Lewis RW, Roberts JA (1981) The renal quantitative scintillation camera study for determination of renal function after anatrophic nephrolithotomy. J Urol 125:287–288CrossRefGoogle Scholar
  13. 13.
    Ramakrishnan PA, Al-Bulushi YH, Medhat M, Nair P, Mawali SG, Sampige VP (2006) Modified anatrophic nephrolithotomy: a useful treatment option for complete complex staghorn calculi. Can J Urol 13:3261–3270Google Scholar
  14. 14.
    Morey AF, Nitahara KS, McAninch JW (1999) Modified anatrophic nephrolithotomy for management of staghorn calculi: is renal function preserved? J Urol 162:670–673CrossRefGoogle Scholar
  15. 15.
    Melissourgos ND, Davilas EN, Fragoulis A, Kiminas E, Farmakis A (2002) Modified anatrophic nephrolithotomy for complete staghorn calculus disease -- does it still have a place? Scand J Urol Nephrol 36:426–430CrossRefGoogle Scholar
  16. 16.
    O’Reilly PH, Brooman PJC, Mak S et al (2003) The long-term results of Anderson–Hynes pyeloplasty. BJU Int 87:287–289CrossRefGoogle Scholar
  17. 17.
    Kijvikai K, Leenanupunth C, Sirisriro R, Lertsithichai P (2004) Comparative study of renal function between standard and modified anatrophic nephrolithotomy by radionuclide renal scans. J Med Assoc Thai 87:704–708Google Scholar
  18. 18.
    Aminsharifi A, Irani D, Masoumi M, Goshtasbi B, Aminsharifi A, Mohamadian R (2016) The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy: a comparative analysis of clinical efficacy and functional outcome. Urolithiasis 44: 551–557CrossRefGoogle Scholar
  19. 19.
    Keshavamurthy R, Karthikeyan VS, Mallya A, Sreenivas J, Nelivigi GG, Kamath AJ (2017) Anatrophic nephrolithotomy in the management of large Staghorn Calculi—a single centre experience. J Clin Diagn Res 11:PC01-PC04Google Scholar
  20. 20.
    Desai M, De Lisa A, Turna B et al On Behalf Of The Croes PCNL Study Group (2011). The clinical research office of the endourological society percutaneous nephrolithotomy global study: staghorn versus nonstaghorn stones. J Endourol 25:1263–1268CrossRefGoogle Scholar
  21. 21.
    Abreu Lde A, Camilo-Silva DG, Fiedler G et al (2015) Review on renal recovery after anatrophic nephrolithotomy: are we really healing our patients? World J Nephrol 4:105–110CrossRefGoogle Scholar
  22. 22.
    El-Nahas AR, Eraky I, Shokeir AA et al (2011) Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones. BJU Int 108:750–754Google Scholar
  23. 23.
    Simmons MN, Schreiber MJ, Gill IS (2008) Surgical renal ischemia: a contemporary overview. J Urol 180:19–30CrossRefGoogle Scholar
  24. 24.
    The Canadian Transplant Study Group (1985). Examination of parameters influencing the benefit: Detriment rates of cyclosporine in renal transplantation. Am J Kidney Dis 5:328CrossRefGoogle Scholar
  25. 25.
    Al-Kohlany KM, Shokeir AA, Mosbah A et al (2005) Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol 173:469–473CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ahmed R. EL-Nahas
    • 1
    Email author
  • Amr A. Elsawy
    • 1
  • Ahmed Abdelhalim
    • 1
  • Mohamed M. Elsaadany
    • 1
  • Yasser Osman
    • 1
  1. 1.Urology Department, Urology and Nephrology CenterMansoura UniversityMansouraEgypt

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