United Knowledge, Expert Care

Open renal surgery

Over the past twenty years, fewer and fewer ureteric and renal calculi are treated by open surgery and, in most stone centres, less than 1% of stones are considered suitable for these techniques. The large, complicated staghorn calculus and large impacted ureteric calculus may well be suitable for open stone surgery with a high chance of stone clearance but with the inevitable morbidity associated with an open incision.

It is clear that both the urologist and patient have a bewildering number of options available for the treatment of any particular stone. These range from those treatments with limited morbidity (i.e. ESWL) through minimally invasive endoscopic options, to invasive open surgery with the highest morbidity but high success rates of stone clearance with a single treatment. Each treatment, therefore, needs to be tailored for the individual patient with stone (size, composition, position) and patient (associated morbidity, size and lifestyle) factors all taken into account. Often patients may choose a more invasive option if it offers a greater chance of success with a single treatment. Others will choose the least invasive option even though they may be embarking upon a journey of many ESWL treatments, which may ultimately prove unsuccessful and lead to an operation anyway. Undoubtedly, these extraordinary advances in surgical stone management have not been mirrored by our ability to prevent further stone episodes for individual patients.

Clearly prevention is the greatest challenge presently facing stone experts and hopefully some advances in this area will be available in the not too distant future.

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