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Comparative Study of Renal Function between Standard and Modified Anatrophic Nephrolithotomy by Radionuclide Renal Scans

704

Kittinut Kijvikai MD*, Charoen Leenanupunth MD*,
Rojana Sirisriro MD**, Panuwat Lertsithichai MD*
* Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
** Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University

Abstract


Objective : To compare the changes in renal function after surgery between standard and modified anatrophic
nephrolithotomy using the technetium 99m-DTPA renal scan in patients with complex staghorn calculi.
Material and Method : From July 2001 to March 2002, standard anatrophic nephrolithotomy (sANL) was
performed in 7 patients with complex staghorn calculi and modified anatrophic nephrolithotomy (mANL)
was performed in another group of 8 patients with the same condition. Preoperative and postoperative renal
function were assessed by technetium 99m-DTPA renal scan.
Results : Mean patient age was 41 years in the sANL group and 45 years in the mANL group. Male to female
ratio was 4:3 in the sANL group and 5:3 in the mANL group. Median operative time was 205 minutes in the
sANL group compare with 180 minutes in the mANL group (P = 0.03). Median estimated blood loss was 300
ml. in the sANL group and 275 ml. in the mANL group (P = 0.17). Median percent reduction of GFR on the
operated kidney was 9.13 (-30.03 to -3.15) in the sANL group and 27.25 (-41.81 to -1.55) in the mANL group
(P = 0.13). Residual small stone was seen in one patient of the sANL group and ESWL was performed for stone
fragmentation. There were no serious short-term complications.
Conclusion : The average operative time of sANL was longer than mANL however, sANL preserved more
renal function than mANL. This study suggested that sANL should be the procedure of choice in patients who
have compromised renal function.

Keyword : Anatrophic nephrolithotomy, Staghorn calculi, Renal scan



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