BACKGROUND: Staghorn calculi (SC) occupy the renal pelvis and calyces and are common in females linked to repeated urinary tract infections (UTIs). Judicious surgery planning reduces the chance of further damage to the kidney due to renal SCs. Open stone surgery (OSS) is one of the various operative techniques to remove such huge stones with one operative intervention and protect the kidney from ongoing functional damage.
METHODS: A 47-year-old male patient presented with right-sided renal colic pain, and on further investigations, he was diagnosed with a large renal stone responsible for substantial renal function impairment on the same side. The SC measured 8 × 4 cm with another stone in the lower calyx. thinner parenchyma, and only 16% relative function. Therefore, open surgery was selected over less invasive approaches because multiple lithotripsy (ESWL) sittings may have been required in less invasive options.
CONCLUSIONS: SCs, which can be complete or partial, often result in renal impairment. Hence, it is crucial to implement a proactive therapeutic approach that includes a thorough evaluation of the stone\'s size and position, the patient\'s choice, and institutional capacity. Complete elimination of SCs is preferred to maintain maximal renal function. Based on clinical, technical, and socioeconomic considerations, open pyelolithotomy or OSS was chosen over percutaneous nephrolithotomy for SC removal in the discussed case.
CONCLUSIONS: The ability to remove large stones in a single intervention with open pyelolithotomy has been very effective due to its distinctive clinical presentation and pathological abnormalities.

UNASSIGNED: With the strong development of percutaneous nephrolithotomy as well as other less invasive procedures, the indication of open surgery for the treatment of nephrolithiasis has been significantly reduced and is only applied in selective cases.
METHODS: A 55-year-old male was admitted to the Department of Urology due to fever and left flank pain. Clinical examination and imaged studies reveal staghorn calculi in the right kidney and infected hydronephrosis with multiple stones on the left side. The stone removal surgery was performed in 2 sessions, left first - right after. The two operations came out with no peri- or post-operative complication, no blood transfusion.
UNASSIGNED: The two reasons for the indication of open surgery instead of percutaneous nephrolithotomy were i/ the stone\'s sizes were very large and very hard, and ii/ the multi-tract nephrolithotomy increased the risks of blood transfusion and parenchymal\'s damage. Also, a long-time and difficult nephroscopy was not the good choice for the left-infected hydronephrosis.
CONCLUSIONS: Open stone surgery is still a good alternative approach for kidney complex stone burden, especially infected hydronephrosis.

BACKGROUND: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS).
METHODS: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications.
RESULTS: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively).
CONCLUSIONS: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases.

UNASSIGNED: A worldwide mounting in the incidence and prevalence of urolithiasis has been observed. The standard treatment of urologic stone disease (USD) has changed from open surgery to extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy (PCNL), or ureteroscopy depending on the size and location of the stone. We are sharing our experience in utilizing Da Vinci® robotic surgical system to treat patient with urolithiasis instead of open surgical approach.
UNASSIGNED: We reviewed prospectively collected data of 19 patients who underwent robotic-assisted stone surgery (RSS) between January 2010 and March 2018 at our institute for USD involving 22 nephroureteral units.
UNASSIGNED: A total number of 22 RSS were accomplished with no conversion to open. Three patients had bilateral stone and needed to have RSS on each side separately. Eleven RSS were performed on the right. The indications for RSS included as follows: morbid obesity (n = 8, mean body mass index 56.4 kg/m2), need for concurrent renal surgery (n = 3) severe contractures limiting positioning for retrograde endoscopic surgery or PCNL (n = 2), symptomatic calyceal diverticular stone with failed endoscopic approach (n = 4), and after failed PCNL (n = 2). Twenty nephrouretral unit (91%) were rendered stone free on the first attempt with complication occurring after four cases (18%).
UNASSIGNED: RSS is viable options in the treatment of challenging urologic stone with high success rate and low risk of complication. The need for open stone surgery was eliminated by RSS at our center.

In the era of minimally invasive surgery, endoscopic and percutaneous interventions for urinary tract stones have become a mainstay, and the need for open stone surgery (OSS) has decreased. We sought to determine the contemporary incidence of OSS among urologists in the United States.
Case logs submitted for certification to the American Board of Urology from 2005 to 2015 were queried for Current Procedural Terminology codes relevant to OSS. Cases were analyzed for the associated practice type, practice area population, geographic region, provider subspecialty, and certifying status of the reporting urologist.
A total of 334 cases of OSS were identified, with 73.4% performed by urologists self-identified as generalists. The most common subspecialists performing OSS were endourologists (12.3%). Most cases were done in the private practice setting (80.4%), and in practice areas with populations exceeding 1,000,000 (43.2%). OSS was more commonly reported by urologists applying for recertification than initial certification. Thirty open stone cases were reported each year on average, and there was no decrease in stone cases over time based on linear regression analysis (R2 = 0.06). OSS was most commonly performed in the Western Section of the American Urological Association (AUA) (25.1%) and least commonly performed in the Northeastern Section (1.5%). A chi-square analysis was performed, and the Western Section had a significantly higher number of OSSs than expected as its urologists represent only 17% of the total AUA membership (p < 0.01). The Northeastern Section comprises 7% of the AUA membership but only performed 1.5% of OSSs that were significantly lower than expected (p < 0.001).
Domestic performance of OSS remains stable. It is unclear as to whether the majority of these cases could be served by less-invasive technologies or whether the volume represents a true nadir. Future work may be warranted to assess attitudes, training, and feasibility of minimally invasive stone management in areas where OSS is most common.

BACKGROUND: Urinary stone disease is a major urological condition. Endourologic techniques have influenced the clinical approach and outcomes. Open surgery holds a historic importance in the management of most conditions. However, complex kidney stone burden may be amenable to successful results with open stone surgery. In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal.
METHODS: A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery. Patients\' demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively. The choice of surgical approach is mostly dependent on the surgeon\'s preference. In two patients, open surgery was undertaken because of perioperative complications.
RESULTS: We did not observe any Clavien-Dindo grade 4 or 5 complications. Three patients were managed with a course of antibiotics due to postoperative fever. One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus. Mean operation time was 84 (57-124) minutes and mean hospitalization time was 5.5 (3-8) days. Stone-free status was achieved in 15 patients (83.3%).
CONCLUSIONS: Endourologic approaches are the first options for treatment of urinary stone disease. However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden. Open stone surgery is also a valid alternative to endourologic techniques in all situations.

OBJECTIVE: To highlight the role of open stone surgery in the management of urolithiasis in the current era of minimally invasive therapies. The introduction and continuous development of extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy and percutaneous nephrolithotomy (PCNL) over the past 30 years have led to a significant change in the current management of urolithiasis, where the indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option.
METHODS: We reviewed the most recent guidelines published by the European Association of Urology and the American Urological Association, and reviewed reports through a MEDLINE search to identify the indications and current role of open stone surgery.
RESULTS: From the MEDLINE search, it was obvious that the number of papers published on open renal stone surgery has decreased during the last three decades, soon after the introduction of ESWL and PCNL.
CONCLUSIONS: Although currently most patients with stones can be managed by minimally invasive therapy, we believe that open surgery still has a role, and therefore it is of great importance to recognise that a small group of patients with complex stone disease, and those with anatomical and physiological anomalies, will benefit from this treatment option.