Is "Open Stone Surgery with Intraoperative Nephroscopy" a Better Alternative to Percutaneous Stone Removal for...

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Endourology advancements have reduced open stone surgeries (OSS).
• Percutaneous nephrolithotomy (PNL) is often infeasible in rural developing areas due to resource limitations.
• Open stone surgery (OSS) remains a necessary option in specific contexts.

Purpose of the Study:

• To evaluate the feasibility and outcomes of open stone surgery (OSS) for complex kidney stones in a rural, resource-constrained setting.
• To share experience with OSS when advanced endourological procedures are unavailable.

Main Methods:

• Retrospective case series analysis of 2241 urinary stone surgeries from January 2012 to June 2023.
• Utilized STROCSS 2025 and PROCESS 2023 checklists for study design and reporting.
• Analyzed demographic data, stone burden, surgical techniques (pyelolithotomy, extended pyelolithotomy, pyelolithotomy with calyceal nephrotomy), and outcomes.

Main Results:

• 49 open stone surgeries (OSS) were performed, primarily for complex stones (93.8% with staghorn calculi).
• Achieved a 95.9% stone-free rate at discharge and 3-month CT.
• Mean operative time was 88.67 minutes, with an average hospital stay of 5.87 days. Intraoperative and significant postoperative complication rates were 10.20% and 14.28%, respectively.

Conclusions:

• Single-session open stone surgery (OSS) with nephroscopic clearance can achieve high stone-free rates.
• OSS may be a safe and effective alternative for complex stone burdens in resource-limited rural areas.
• While morbidity is higher than PNL, OSS provides a crucial treatment option where advanced techniques are unavailable.