The role of open stone surgery in the management of urolithiasis.

The establishment of extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, and ureteroscopy as the primary treatment modalities for almost all renal and ureteral calculi has greatly diminished the role of open stone surgery. We reviewed our most recent experiences with open stone surgery to determine the current indications and to establish what role open surgery plays in the management of urolithiasis. We conducted a retrospective review of all patients undergoing open stone surgery during a consecutive 60-month period from 1991 through 1995 at three university-affiliated hospitals. Hospital and office charts, operative notes and records, and pertinent radiographic studies were reviewed. Of the 780 therapeutic stone procedures performed, 42 were open surgical procedures (5.4%), including pyelolithotomy [15], anatrophic nephrolithotomy [14], ureterolithotomy [7], and radial nephrolithotomy [6]. The most common indications for open stone surgery were complex stone burden, previous treatment failures with less-invasive modalities, anatomical abnormalities involving the renal collecting system, and patient comorbid medical problems. The stone-free rate following open surgery was 93%. There were five complications. Based on our experience, we discuss our current indications for open stone surgery.