Indications for Surgery and Surgical Techniques in Staghorn Calculi

Abstract

The indications for surgical intervention in staghorn calculi have changed considerably during the past 25 years. Conservative surgery, formerly rare, is now practically the rule. There is usually no reason to postpone the procedure once the lithiasis is discovered. Sometimes, the stone has to be removed as an emergency, in the presence of acute infection or renal failure. In the majority of cases a thorough preoperative check-up is required, including (in addition to intravenous pyelogram) lateral x-ray of the kidney, tomography, isotopic assessment of separated renal function and possibly arteriography.

Two main types of surgical procedures, the sinus and the transparenchimal approaches, are usually carried out.

The choice of the procedure depends upon various factors such as the extent of the staghorn calculi, the intrarenal situation of the pelvis, the thickness of the parenchyma, possible previous intervention, renal insufficiency and also on the preference of the surgeon and his team for a particular technique with which they are more familiar.

Partial nephrectomy may be resorted to, in order to clear the kidney of the stones or to remove lithogenic areas. When staghorn calculi are responsible for severe renal failure, they must be removed in the most atraumatic way (intrasinus approach and multiple small nephrotomies) avoiding clamping of the renal pedicle.