Giant Multicompartment Renal Calculi Managed by Simultaneous Open Pyelolithotomy and Targeted Nephrolithotomies
Indian Journal of Surgery, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s12262-026-04704-w
- Dergi Adı: Indian Journal of Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Anahtar Kelimeler: Nephrolithotomy, Open surgery, Pyelolithotomy, Renal calculi, Urolithiasis
- Gazi Üniversitesi Adresli: Evet
Özet
A 59-year-old man presented with left flank pain and no previous stone intervention. Non-contrast computed tomography demonstrated multiple calculi occupying the left renal pelvis and the upper-, middle-, and lower-pole calyces. The dominant component measured 8 × 5 cm with an attenuation of approximately 1500 HU, the summed largest dimensions exceeded 15 cm, and the S.T.O.N.E. nephrolithometry score was 11, indicating high stone complexity. Serum creatinine was 1.1 mg/dL, preoperative urine culture was negative, and dimercaptosuccinic acid scintigraphy (DMSA) showed 33% relative function in the affected kidney, supporting renal preservation. Multitract or staged percutaneous nephrolithotomy and endoscopic combined intrarenal surgery were considered; however, four spatially separate stone-bearing compartments were expected to require repeated access, extensive fragmentation, and potentially multiple sessions. After discussion of treatment alternatives and the greater invasiveness of open surgery, simultaneous open pyelolithotomy and three targeted nephrolithotomies were performed through a transabdominal approach without hilar clamping. The largest extracted fragment measured approximately 7 cm. The postoperative course was uncomplicated, renal function remained stable, and postoperative non-contrast computed tomography confirmed complete stone clearance. This case illustrates that open extraction may remain a reasonable kidney-preserving option when extreme multicompartment stone burden makes a minimally invasive programme disproportionately complex.