title: Modified anatrophic nephrolithotomy for management of staghorn calculi: is renal function preserved?
abstract: OBJECTIVE
  We report the results of modified anatrophic nephrolithotomy in select patients with complex staghorn calculi.
  
  
  METHODS
  From 1987 to 1997 modified anatrophic nephrolithotomy, including 1 bilateral procedure, was performed in 15 patients at San Francisco General Hospital. Preoperative imaging included excretory urography, sonography and computerized tomography. Preoperative and postoperative quantitative renal function was assessed with 99mtechnetium dimercapto-succinic acid renal scintigraphy and serum creatinine measurements.
  
  
  RESULTS
  Mean patient age was 42 years and 11 of the 15 patients were male. Bilateral nephrolithotomy was performed in 1 patient on separate occasions. Average surgical time was 3.7 hours with blood loss of 325 ml. Length of hospital stay averaged 4 days. Residual stones were present after 3 procedures, and 1 of these patients required a secondary procedure. There were no other short-term complications. Renal function was not significantly altered.
  
  
  CONCLUSIONS
  Modified anatrophic nephrolithotomy for staghorn renal stones rendered most patients stone-free with concomitant preservation of renal function. Because of its safety, efficacy and simplicity we believe that continued use of this procedure is warranted in select patients with complex renal stone disease.
authors.affiliation: Department of Urology, University of California School of Medicine and San Francisco General Hospital, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Morey
authors.forename: K S
authors.initials: KS
authors.lastname: Nitahara
authors.forename: J W
authors.initials: JW
authors.lastname: McAninch
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000378:metabolism; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011866:Radioisotope Renography; D013520:Urologic Surgical Procedures / Q000379:methods
chemical_list: D003404:Creatinine