[Nephrotomy using in situ hypothermic perfusion. Apropos of a case]

The case of a 14 year old boy, suffering from severe bilateral nephrolithiasis, secondary to cystinuria, is presented. The progressive increase of the lithiasis, the dilatation of the excretory system of the right kidney and the painful passage of stones justified surgical removal of the staghorn stones on the right. The nephrolithotomy was performed under hypothermic perfusion of the kidney in situ, with section of the renal artery. This allowed an exsanguineous nephrotomy and the complete removal of all the stones. Anatomical repair of the calyces was possible, renal artery was re-anastomosed and the opening of the renal vein sutured without difficulty. No complication was encountered in the postoperative period, renal function remaining good. The intravenous pyelogram at the 15th postoperative day showed a marked improvement of the hydronephrosis. The authors review the literature describing the different methods of ischemic nephrotomy and compare the advantages of the procedure chosen in their case with the others : these advantages are the good preservation of the kidney, a bloodless nephrotomy, the long time allowed for the procedure and the removal of all the stones, and the possibility to continue the operation ex vivo when necessary, even using microsurgery.