Giant Left Staghorn Kidney
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The patient is a 55-years old male, with BMI of 30, who complained of occasional left flank pain, since 1 to 2 years before admission. He also complained of irritative lower urinary tract symptoms & dysuria.

In renal ultrasonography, a large left staghorn kidney was reported. In IVP a huge semiopaque density was seen in left kidney The urine culture was positive for E coli growth.

Due to large volume of stone and its complexity, the patient was scheduled for left anatrophic nephrolithotomy. The patient underwent open stone surgery, with left flank incision, after ligating the renal artery and opening the kidney with nephrotomy incision, the stone was removed completely within 5 min after artery ligation. The stone weight was 123 grams. Stone biochemical analysis was in favor of struvite stone.

Points to Remember:-
1. Open stone surgery, are losing its role day and day, but sometimes its using becomes inevitable due to patients characteristics, failure of primary therapy for stone removal, complex stone burden, renal anatomic problems.
2. ESWL, PCNL and TUL are advanced noninvasive or less invasive techniques of renal and ureteral stones treatment.
3. PCNL is a valuable treatment option for complete Staghorn stones with a stone-free rate approaching that of open surgery. Moreover, it has the advantages of lower morbidity, shorter operative time, shorter hospital stay and earlier return to work.
4. Percutaneous nephrolithotomy is superior to shockwave lithotripsy or open surgery in the treatment of Staghorn calculi

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