Open Pyelolithotomy Expert Care

Risk Factors

Risk factors for large kidney stones:

• Low daily fluid intake
• High protein and oxalate diet
• History of prior kidney stones
• Family history of nephrolithiasis
• Metabolic syndrome and obesity
• Urinary tract structural abnormalities

Who is at Risk

Patients with large or staghorn kidney stones, those with complex renal anatomy, patients who have failed endoscopic stone treatment, and those requiring simultaneous correction of urinary obstruction are candidates for open pyelolithotomy.

Diagnosis

Pre-operative evaluation includes:

• Ultrasound for stone size and kidney assessment
• Non-contrast CT KUB for complete stone mapping
• IVP or CT urogram for anatomy and drainage assessment
• Urine culture to exclude active infection
• Renal function tests and metabolic stone workup

Treatment Options

Open pyelolithotomy is performed via a flank or lumbotomy incision. The renal pelvis is opened (pyelotomy) and stones are removed under direct vision. Concomitant pyeloplasty for UPJ obstruction can be performed simultaneously.

The Procedure

Open pyelolithotomy involves:

• General anesthesia with patient in lateral or supine position
• Flank or lumbotomy incision to expose the kidney
• Renal pelvis identification and isolation
• Pyelotomy incision for stone access
• Stone removal under direct vision with intraoperative X-ray guidance
• Irrigation and inspection for residual fragments
• Pyelotomy closure with absorbable sutures and drain placement

After the Surgery

Post-operative recovery includes:

• Hospital stay of 3 to 5 days
• Drain removal at 24 to 48 hours
• Ureteral stent removal at 4 to 6 weeks if placed
• Oral hydration and dietary stone prevention advice
• CT KUB at 6 weeks to confirm stone clearance
• Metabolic stone workup to prevent recurrence

Possible Complications of Open Pyelolithotomy

Potential complications include:

• Urinary leak from pyelotomy closure
• Residual stone fragments requiring additional treatment
• Wound infection or haematoma
• Renal injury or bleeding requiring transfusion
• Urinary tract infection post-operatively
• Injury to adjacent structures such as bowel or spleen