Anatrophic Nephrolithotomy

Management of urinary stones is still a challenge. Anatropic Nephrolithotomy is preferred due to its minimal invasive techniques and combined with effective surgical procedures.

Anatrophic nephrolithotomy is widely used for full staghorn calculus surgery/ complex kidney reconstructions and partial amputations in a solitary kidney.

Advantages:

  • Still preferred over percutaneous nephrolithotomy/ extracorporal lithotripsy/ endourologic methods.
  • Minimal blood loss,
  • Minimum pain,.
  • High stone-free rates.
  • No blood transfusion.
  • Utmost comfort to the patient.
  • Parenchymal Preservation.

Length Of The Surgery:

2- 3 hours.

Causes:

  • Full staghorn calculus
  • Complex renal reconstructions
  • Partial amputations of solitary kidney.

Diagnosis:

Percutaneous Nephrolithotomy is recommended after the following diagnosis tests.

  • Physical exam
  • Medical history.
  • X-ray.
  • CT scan.
  • MRI scan.
  • Cystoscopy.

Symptoms:

  • All the symptoms of urinary stones.
  • Problematic urination.
  • Reduced volumes of urine.
  • Penile/ testicular aches.
  • Occurrence of blood in the urine.
  • Urgency of urination.
  • Frequent fevers.
  • Occasional chills.
  • Nausea.
  • Vomiting.
  • A fluctuating pain in the lower back, groin, or abdomen area.

Preparation:

  • Slush Preparation:
  • Slush needs to be used immediately after the renal vasculature occlusion.
  • Some Dry ice is contained in a large basin with an empty stainless steel bowl fixed in the centre of the basin, so that the bowl is entirely surrounded with dry ice, up to its rim.
  • A saline solution is poured in the bowl, once it becomes frosty, and the solution is stirred for 4 to 5 minutes.
  • Thus, slush is formed.
  • In order to, trap the stones, Coagulum is prepared without the use of Thrombin.
  • Venous/ Arterial Isolation is performed by the use of a bulldog vascular clamp.

Procedure:

  • After the above preparations, a parenchyma incision is targeted on an plane which is inter-segmental. This facilitates removal of renal calculi, large in sizes.
  • Kidney may need to be mobilized and this is done by a simple flank incision.
  • After the isolation of the main renal artery, identification of the segmental posterior artery is necessary.
  • The anatrophic plane is defined by occluding This segemntal posterior artery is occluded by the intravenous administration of the methylene. R, and thus is defined the anatrophic plane.
  • The calculi are extracted, which may If require stenotic infundibula incision is performed to extract the stone.
  • The confirmation of total stone removal is concluded by the intra-operative radiography
  • Absorbable sutures correct the collecting system and special methods need to be implemented for the infundibular stenosis correction. The absorbable sutures are used to close the renal capsule and concluded with the re-establishment of the renal function.

Risks:

  • The PCNL potential risks include:
  • Deep Vein Thrombosis in obese patients.
  • Slightly abnormal renal function.
  • Slightly degraded renal function.

Follow- up:

It’s usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest there could be a problem, such as:

  • 24hour surveillance.
  • Drink 8 to 10 glasses of water.
  • Empty bladder regularly.
  • Do not suppress the sensation to urinate.
  • Avoid torso movement.
  • Avoid aerobics.
  • 5 days to 1 week hospital stay for observation in case of complications.
    Visit doctor:
  • Conservative treatment of complications.
  • Developed Hematuria/ UTI.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Deep Vein Thrombosis

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.