Is “Open Stone Surgery with Intraoperative Nephroscopy” a Better Alternative to Percutaneous Stone Removal for Complex Kidney Stones in Resource-Constrained Rural Settings?: A Retrospective Observational Cohort Study

Joy Narayan Chakraborty, Renchamo Kikon Department of General Surgery, Zion Hospital, Dimapur, Nagaland, IndiaCorrespondence: Joy Narayan Chakraborty, Email [email protected] and Importance: Advances in endourology have greatly reduced open stone surgeries (OSS) worldwide. However, in some rural areas of developing countries, PNL for large, complex stones is not feasible due to limited resources and lack of angioembolisation. We share our experience in such cases.Materials and Methods: Using STROCSS 2025 and PROCESS 2023 checklists, we outlined objectives and reported a case series. From January 2012 to June 2023, 2241 patients had surgery for urinary stones at a rural hospital: 286 PNL, 1625 URS, 281 RIRS, and 49 OSS. We retrospectively analysed demographic data, stone burden, surgical techniques, and outcomes.Outcomes: There were 23 men and 26 women, aged 31 to 66 (average: 52 years). CSB was included in 46 patients (93.8%), and CSB with PUJ obstruction in 3 patients (6.12%). Procedures were pyelolithotomy (26.53%), extended pyelolithotomy (38.77%), and pyelolithotomy with lower calyceal nephrotomy (24.48%). Mandatory intraoperative nephroscopy was used to remove calyceal stones. Complete stone-free status was achieved in 47 cases (95.9%) at discharge and 3-month CT. Two patients (4.08%) had residual fragments needing RIRS at 3 months. The mean operative time was 88.67 min (70– 120), and hospital stay averaged 5.87 days (5– 8). The follow-up period averaged 24.48 months (24– 30). Intraoperative complications occurred in 10.20%, and significant postoperative complications in seven cases (14.28%), including sepsis, urinary leakage, chest effusion, and wound issues.Conclusion: Single-session OSS with Nephroscopic clearance can achieve a higher stone-free rate. Although the morbidity of OSS is considerably higher than that of PNL, it may be safe and effective for managing complex stone burdens in resource-constrained rural areas of developing countries.Keywords: complex renal stones, open stone surgery, rural kidney stones, intraoperative nephroscopy, case series, calycotomy