Surgical managing of nephrolithiasis has altered dramatically in the last few decades. While previously most of the patients required an open surgical approach but today less invasive procedures, such as extracorporeal shock waves lithotripsy (ESWL), percutaneous nephrolithotripsy (PNL), ureterorenoscopy (URS) has promoted a rapid decline in the utilize of open surgery for the both ureteral and renal stones. In the era of minimal invasive treatments, laparotomy is not often required, but it is important to recognize patients in which open anatrophic nephrolithotomy could be a best choice of treatment.
From past 30 years urologists are using anatrophic nephrolithotomy procedure for removal of large renal stones, specifically branched or staghorn stones (if these stones are present in the body the symptoms like flank pain, fever and hematuria will occur (or) they may be asymptomatic). These stones are often related with urinary tract infections. Anatrophic nephrolithotomy not only used for full staghorn stone surgery but also can be used for complex kidney reconstructions and partial amputations in a solitary kidney.
PROCEDURE OF ANATROPHIC NEPROLITHOTOMY:
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The operation is mainly based on the principle of placing the nephrotomy incision through a plane of the kidney that was relatively avascular.
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This procedure would avoid the damage to the renal vasculature which results in atrophy of the renal parenchyma, hence it is termed as anatrophic.
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The operation may also includes the procedure of reconstruction of the intrarenal collection system and to get rid of anatomic obstruction, thereby improvement of urinary drainage, reducing the probability of urinary tract infection, and preventing recurrent stone formation.
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This surgery indicate for the treatment of staghorn calculi in the patients who are benefit from or prefer a single therapeutic procedure versus multiple, less invasive, procedures such as extracorporeal shock wave lithotripsy and/or percutaneous nephrolithotomy.
Significant postoperative renal hemorrhage should occur in less than 10% of patients.
