[Operative methods and their problems in the surgical treatment of renal staghorn calculi]

Percutaneous nephrolithotripsy and extracorporeal shock wave lithotripsy are entering the stage of clinical use. Herein, all of the operative methods for renal staghorn calculi used today are reviewed and their problems discussed. Concerning extended pyelolithotomy, which is thought to be the most desirable operative approach to the staghorn calculi, restrictions of indication, such as shapes of calculus and pelviocalyceal system, thickness of renal parenchyma are presented. The literature on nephrolithotomy, not only on advances of protection for damage of renal parenchyma due to ischemia, incision and suture, but also on vascular damage due to pedicle clamping are discussed, and delayed bleeding after nephrolithotomy about its incidence and modern methods of conservative treatment, transcatheter embolization are reviewed.