Nefrolitotomi

Nefrolitotomi, known in English as nephrolithotomy, is a surgical procedure for removing stones from the kidney by making an incision into renal tissue or the renal collecting system. Historically performed as open surgery, it has largely been superseded by less invasive techniques, with percutaneous nephrolithotomy (PCNL) becoming the standard for large or complex stones. Open and, less commonly, laparoscopic nephrolithotomies are still employed in certain settings.

Indications for nefrolitotomi include large renal calculi typically greater than 2 cm, staghorn stones that occupy multiple calyces, stones not amenable to extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic lithotripsy, and certain anatomies or infections that require direct removal of stone burden. It may also be considered when there is obstruction or compromised kidney function due to stones.

Techniques: Modern practice favors PCNL for substantial stone disease. This involves creating a percutaneous tract into the kidney under imaging guidance, introducing a nephroscope to visualize and fragment the stone, and removing fragments. A nephrostomy tube or ureteral stent usually remains postoperatively. Open nephrolithotomy involves a flank incision to expose the kidney, extract the stone, and repair the collecting system, with longer recovery. Laparoscopic nephrolithotomy is a less common alternative.

Outcomes and risks: Stone-free rates after PCNL vary with stone size and complexity but are commonly high for large stones. Complications include bleeding requiring transfusion, infection or sepsis, urine leakage, and injury to kidney or adjacent organs. Recovery times are shorter with PCNL than with open surgery, but longer than minimally invasive endoscopic approaches in some cases.

See also: nephrolithiasis, percutaneous nephrolithotomy, ESWL, ureteroscopy.