Kidney Stone Open Surgery

Who Needs Open Kidney Stone Surgery?

Open surgery is recommended for patients with very large kidney stones above 3 cm, staghorn calculi filling the renal pelvis and calyces, stones in kidneys with anatomical anomalies such as horseshoe kidney, stones that have failed previous minimally invasive treatments, and cases where significant obstruction or infection requires urgent complete stone clearance.

Diagnosis

Diagnosis of kidney stones requiring open surgery involves:

• Urine analysis to detect blood, crystals, and signs of infection
• Blood tests to assess kidney function, calcium, and uric acid levels
• X-ray KUB to detect radiopaque stones in the kidney and urinary tract
• Ultrasound of the kidneys and bladder to assess stone size and hydronephrosis
• CT scan of the abdomen and pelvis for precise stone characterization
• IVP or nuclear renogram to evaluate kidney function and drainage

Surgical Procedure

Open kidney stone surgery is performed under general anesthesia. The surgeon makes a flank or subcostal incision to access the kidney. In nephrolithotomy, the kidney is incised to remove the stone. In pyelolithotomy, the stone is removed through the renal pelvis. The collecting system is repaired with absorbable sutures. A nephrostomy tube may be placed for post-operative drainage.

Open Kidney Stone Surgery Steps

The open kidney stone surgery procedure involves:

• Administration of general anesthesia and positioning the patient in lateral decubitus
• Making a flank incision to access the retroperitoneal space
• Exposing the kidney and identifying the stone location using intra-operative X-ray
• Incising the kidney (nephrolithotomy) or the renal pelvis (pyelolithotomy)
• Removing the stone or stone fragments completely
• Inspecting the collecting system for remaining fragments
• Closing the kidney with absorbable sutures
• Placing a drain and closing the wound in layers

After the Surgery

Recovery after open kidney stone surgery takes 4 to 6 weeks. Hospital stay is typically 4 to 7 days. Patients should maintain high fluid intake of at least 2 to 3 liters per day. A nephrostomy tube if placed is removed within a few days. Physical activity is restricted for 4 to 6 weeks. Dietary modifications to prevent stone recurrence are advised along with metabolic evaluation.

Complications of Open Kidney Stone Surgery

Potential complications of open kidney stone surgery include:

• Bleeding requiring blood transfusion
• Urinary leakage from the repaired collecting system
• Wound infection or abscess formation
• Injury to surrounding structures such as the ureter or bowel
• Pneumothorax if the incision is near the pleura
• Residual stone fragments requiring additional treatment
• Kidney function impairment in the operated kidney