[Surgical treatment of staghorn calculi of the kidneys]

Between 1971 and 1981, 120 patients or 127 kidneys underwent surgery for staghorn calculi in the Department of Urology at the University of Berne. The following surgical procedures were performed: 7 primary nephrectomies, 29 intrasinusal pyelotomies by the method of Gil-Vernet, 69 nephrotomies, 17 partial resections and 5 nephrotomies combined with partial resection of the kidney. All the surgical procedure in the parenchyma were done in cold ischemia produced by regional cooling of the surface with ice. In our retrospective study special emphasis is placed on important functional aspects of the surgical technique and possible intraoperative and early postoperative complications. Secondary nephrectomy was necessary in only one case. In 102 patients it was possible to record the late results after an average observation time of 4.8 years. 75% of the patients showed good results i.e. they were free of infections and stones and the intravenous urogram was functionally satisfactory. 15.6% had residual stones or recurrent stone formation whereas only 4.9% presented with chronic urinary infections resistant to therapy despite the absence of detectable stones. In 25 patients who underwent differential 131I-hippuran clearance studies the average loss of function was 8.6% for the kidney operated on in hypothermia. In the same 10-year period there were only 7 cases with staghorn calculi (all over 55 years of age) in which primary nephrectomy was necessary because of silent hydronephrosis or pyonephrosis. Our results are compared with a series published by Blandy and Singh who followed 60 patients in whom staghorn calculi were treated exclusively by conservative means. Today new surgical techniques make it possible to free the kidney of staghorn calculi without major loss of renal function, and they remain free of calculi and infection if the metaphylaxis is carefully followed.