Anatrophic Nephrolithotomy Care

Risk Factors

Factors associated with staghorn stone formation:

• Recurrent urinary tract infections
• Urinary stasis from anatomical obstruction
• Metabolic stone disorders
• Indwelling urinary catheters or stents
• Neurogenic bladder or spinal cord injury

Who is at Risk

Patients with complete staghorn calculi, those with complex bilateral stone disease, and patients with multiple failed endoscopic attempts who require definitive surgical clearance are candidates for anatrophic nephrolithotomy.

Diagnosis

Pre-operative assessment includes:

• Non-contrast CT KUB for complete stone and anatomy mapping
• CT urogram for collecting system and infundibular anatomy
• Isotope renogram for differential renal function
• Urine culture and sensitivity testing
• Metabolic stone workup including serum calcium and uric acid
• Renal function tests and blood group and save

Treatment Options

Anatrophic nephrolithotomy involves a nephrotomy through the avascular Brodel line with temporary renal cooling using ice slush or cold saline perfusion. All stones are removed under direct vision with intraoperative imaging guidance. Infundibuloplasty may be performed for stenotic calyces.

The Procedure

Anatrophic nephrolithotomy involves:

• General anesthesia with patient in flank position
• Flank incision and complete kidney mobilization
• Renal artery occlusion for temporary ischemia with ice slush cooling
• Nephrotomy along the avascular Brodel line
• Systematic removal of all stones from pelvis and calyces
• Intraoperative fluoroscopy to confirm complete clearance
• Infundibuloplasty for calyceal stenosis if required
• Watertight nephrotomy closure with drain placement

After the Surgery

Post-operative care includes:

• Hospital stay of 5 to 7 days
• Nephrostomy tube and drain management
• Ureteral stent removal at 4 to 6 weeks
• Renal function monitoring with serum creatinine
• CT KUB at 6 weeks to confirm stone-free status
• Metabolic evaluation and long-term stone prevention

Possible Complications of Anatrophic Nephrolithotomy

Potential complications include:

• Significant blood loss requiring transfusion
• Urinary fistula or urinoma from nephrotomy closure
• Residual stone fragments requiring secondary treatment
• Acute kidney injury from ischemia
• Wound infection or retroperitoneal hematoma
• Long-term reduction in kidney function