pyelolithotomy

Pyelolithotomy is a surgical procedure to remove renal pelvic stones by making an incision into the renal pelvis (pyelotomy) to extract calculi. It is an open surgery once common in the management of kidney stones and is now performed less frequently, reserved for specific circumstances where other endoscopic or minimally invasive methods are unsuitable or have failed, particularly for large or complex stones involving the renal pelvis.

Indications for pyelolithotomy include large renal pelvic stones or staghorn calculi that are not easily accessed or cleared by less invasive techniques, stones in a solitary kidney, and situations where anatomy or stone burden limits endoscopic fragmentation. Contraindications include significant comorbidity that precludes surgery or untreated active infection.

The procedure is typically performed under general anesthesia and may be done via a flank or loin incision to access the kidney retroperitoneally. After exposing the renal pelvis, the pelvis is opened (pyelotomy) to remove the stones, either intact or in fragments. The collecting system is irrigated to remove residual material, and the pelvis is closed. A drain or nephrostomy tube is often placed, and a ureteral stent may be inserted. Postoperative imaging is used to confirm stone clearance.

Outcomes of pyelolithotomy include high stone-free rates in appropriately selected patients, but the approach requires longer recovery and hospital stay than many minimally invasive options. Potential complications include bleeding, urinary leakage, infection, injury to renal tissue or the collecting system, urinoma, and, less commonly, ureteral injury or stricture.