[A Case of Staghorn Calculi Treated by Pyelolithotomy Through a Mini-Pararectal Incision].

Abstract

We report a case in which pyelolithotomy through a mini-pararectal incision was performed in a patient with right staghorn calculi for whom it was difficult to perform PNL/ECIRS. A 76-year-old woman with right staghorn calculi (60×30×30 mm; total stone volume, 51.29 ml) was admitted to our hospital. The patient had undergone left pelvic bone resection and left external iliac arteriovenous graft replacement for left pelvic osteosarcoma 25 years prior and subsequently required anticoagulant therapy. Anticoagulants were suspended, and heparin and the antibiotics were administered intravenously for three days before surgery. Right pyelolithotomy was performed through an 8 cm pararectal incision in the supine position. A T-shaped incision (5×3 cm) was made in the anterior wall of the renal pelvis and the entire stone was extracted. The operative time was 203 min. Blood loss was 95 g. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day. The patient successfully achieved stone-free status. This surgical procedure is a viable option in cases in which endourologic lithotripsy is difficult to perform.