Nefrolitotoomia

Nefrolitotoomia, also known as nephrolithotomy, is a surgical procedure for removing stones from the kidney. It is an open operation in which the kidney or renal pelvis is accessed through an incision, and the stones are extracted. The procedure is selected when stone burden is large or complex, when stones are not amenable to less invasive options, or when rapid stone clearance is required.

Indications for nefrolitotoomia include large renal stones, complex stone patterns such as staghorn calculi, stones causing obstruction, persistent infection, failure of less invasive treatments (such as extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy), or anatomic considerations that limit endoscopic approaches.

Technique: Under general anesthesia, the patient is positioned laterally or prone. The kidney region is exposed via a flank or retroperitoneal incision. The kidney or renal pelvis is incised to access the collecting system; stones are removed intact or after fragmentation; the collecting system is repaired, and a drain or nephrostomy tube and/or a ureteral stent may be placed. The incision is closed, and the patient is monitored postoperatively.

Outcomes: Stone clearance depends on stone burden and anatomy. Nephrolitotoomia provides definitive removal of stones but carries risks of bleeding, infection, urine leakage, and injury to renal tissue. Hospital stay is typically longer than for endoscopic procedures, and recovery may take weeks.

Context: Today, nephrolithotomy is less commonly performed, with percutaneous nephrolithotomy (PCNL) and endourologic techniques preferred for most large or complex stones. Open nephrolithotomy may still be used in certain centers or unusual clinical situations.