title: Modified anatrophic nephrolithotomy: A useful treatment option for complete complex staghorn calculi.
abstract: BACKGROUND
  Management of complete staghorn calculi represents a challenging problem for urologists. We describe our technique and clinical experience with modified anatrophic nephrolithotomy in patients harboring large, extensively branched staghorn calculi.
  
  
  METHODS
  From October 1996 to February 2005 twenty-six patients with complete staghorn calculi defined as filling the entire collecting system or at least 80% of it, were treated employing a modification of the classical anatrophic nephrolithotomy technique. The mean patient age was 46 (range 16-70) years and the mean stone size was 3150 (range 1375-4800) mm2. Intra-operative data, complications and stone-free rates were recorded. Long-term follow-up was completed in 22 patients with a mean duration of 38 (range 12-96) months. Renal function was evaluated by 99mTc dimercapto succinic acid renal scintigraphy before and 6 months after treatment.
  
  
  RESULTS
  The mean ischemia time was 36 (range 20-45) minutes, mean operative time was 195 (range 170-235) minutes and the mean blood loss was 475 (range 300-750) ml. Length of hospital stay averaged 8.8 days. One patient developed significant hematuria requiring renal angiography and embolization of a pseudoaneurysm. Overall, 22 patients (85%) were rendered stone-free at discharge while 23 patients (88%) were observed to be stone-free after 3 months. Long-term follow-up demonstrated recurrent stone fragments less than 4 mm in three patients. Isotope studies revealed that renal function remained unchanged in 55%, improved in 32% and became worse in the small number of remaining patients.
  
  
  CONCLUSIONS
  Modified anatrophic nephrolithotomy is a valuable treatment option for patients with complete staghorn calculi. Because of its efficacy, safety and simplicity we believe that the use of this surgical procedure is warranted in patients with a large, extensively branched, complex renal stone burden.
authors.affiliation: Department of Urology, Armed Forces Hospital, Muscat, Sultanate of Oman.
authors.forename: Prem A
authors.initials: PA
authors.lastname: Ramakrishnan
authors.forename: Younis H
authors.initials: YH
authors.lastname: Al-Bulushi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Medhat
authors.forename: Priti
authors.initials: P
authors.lastname: Nair
authors.forename: Salma G
authors.initials: SG
authors.lastname: Mawali
authors.forename: Venkat P
authors.initials: VP
authors.lastname: Sampige
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*