Does Open Stone Surgery Still Play a Role in the Treatment of Urolithiasis? Data of a Primary Urolithiasis Center

Objective: The introduction and continuous development of percutaneous nephrolithotomy, the achievement of extracorporeal shock-wave lithotripsy, and the advancements in ureterorenoscopy have led to a revolution in the interventional management urolithiasis. The indications for open stone surgery have been narrowed significantly making it a second-or third-line treatment option. We report on patients undergoing open stone surgery for nephrolithiasis in our department during the last 10 years to examine our indications at a primary urolithiasis center and to determine the clinical situations in which open surgery is a reasonable alternative. Patients and Methods: We reviewed all patients undergoing open stone surgery for upper urinary tract stones from 1997 until 2007 at the Department of Urology, University Hospital Mannheim. A retrospective chart analysis was performed on these patients to identify factors and indications for open stone surgery. Indications for stone surgery, type of surgery performed, stone complexity, anatomical abnormities present, and the residual stone burden were reviewed. Results: During a 10-year period 26 open stone operations were performed in our high-volume center. Indications for open stone removal were complex stone mass with complete or partial staghorn stones, concomitant open surgery, nonfunctioning stone-bearing lower poles, the desire to facilitate future stone passages in cystine stone formers, multiple stones in peripheral calyces, and failed minimal invasive procedures. Procedures performed for stone removal included radial nephrotomies, extended pyelolithotomy, lower pole resection, partial nephrectomy, and ileum ureter replacement. Immediate stone-free rate after a single procedure was 69% (18 = 26 patients). Conclusions: Although today most stone cases can be handled by minimally invasive treatment, open stone surgery maintains a mandatory role in very selected cases. The most common indication in our series though was complex stones with a high stone burden especially in combination with anatomical variations.