Open stone surgery — most often performed as anatrophic nephrolithotomy — is a major operation that opens the kidney directly to remove a large or complex "staghorn" stone that less invasive methods can't safely clear. It's used today only when keyhole options such as PCNL, ureteroscopy or shockwave lithotripsy aren't suitable or haven't worked.
A large staghorn stone filling the kidney's drainage system, when less invasive options — PCNL, ureteroscopy or shockwave lithotripsy — have already been tried without clearing the stone, or when kidney or ureter anatomy makes keyhole access unsafe.
Significant bleeding (occasionally needing a transfusion), infection, and risks associated with general anaesthesia. Risks are minimised by careful patient selection and experienced surgical teams.
CT imaging to map the stone, blood and urine tests, and an anaesthesia consultation (this surgery is done under general anaesthesia); some medications, including blood thinners, may need to be paused beforehand.
Monitoring in hospital for several days, a stent-removal visit at 1–4 weeks if a stent was placed, and follow-up imaging to confirm the kidney has healed and to watch for new stone formation.
Anatrophic nephrolithotomy is a technique first described in 1968 for removing very large, branching kidney stones — called staghorn calculi — that fill much of the kidney’s internal drainage system. The surgeon opens the kidney along a naturally low-blood-vessel line (the avascular plane of Brödel), rather than cutting blindly through tissue. This lets the stone be lifted out through the middle of the kidney while limiting damage to the surrounding kidney tissue and blood supply. The kidney is temporarily cooled to protect it while blood flow is paused, the stone is removed, and the kidney is stitched back together and reconnected to its blood supply. Some centers now perform the same technique laparoscopically or robotically, which can mean a smaller incision and a shorter recovery for suitable patients.
A stone being „big” isn’t, on its own, a reason for open surgery — it’s specific symptoms and anatomy together that point this way. Watch for:
On their own, these symptoms just mean it’s time for imaging and a specialist opinion — not that open surgery is the answer.
Open surgery also becomes more likely when the kidney’s own shape or structure makes keyhole access difficult. These are the conditions linked to this treatment in the directory. Your clinician decides whether treatment is appropriate using your symptoms, examination and test results.
Remember: These entries are not a diagnosis or a treatment recommendation. Discuss your symptoms and test results with a qualified clinician.
Most people with kidney stones never need open surgery — it’s reserved for a small number of complex cases, so there’s no need to assume the worst if you’re reading this. A simple blood and urine test, together with imaging, is usually enough for a urologist to see what you’re dealing with and talk you through the realistic options. If you have ongoing flank pain, recurring infections, fever with kidney pain, or blood in your urine — or you already know you have a large or staghorn stone — it’s worth getting that assessment soon rather than waiting it out. [Find a specialist] to book a consultation and get a clear picture of your options.
Before surgery: You’ll have imaging (usually a CT scan) to map the stone, blood and urine tests, and a discussion of anaesthesia (this is done under general anaesthesia). Your surgeon will review any medications that need to be paused beforehand, including blood thinners.
During surgery:
Immediately after surgery: You’ll wake up with a surgical drain near the incision and possibly a temporary ureteral stent. Pain control, early walking, and monitoring for bleeding or infection are the focus of the first 24–48 hours.
The trade-off of a bigger operation is that it can finish the job in one go, which matters most for the largest, most complex stones.
The treatment has risks and trade-offs to discuss with your care team. The information below comes from this treatment’s data.
Bleeding, infection and anaesthesia-related issues are the main concerns; risks are minimised by careful patient selection and experienced surgical teams.
Who it may not suit: These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment.
Most patients stay in hospital for several days to about a week. The drain is usually removed before discharge; a stent, if placed, is typically removed by your urologist within 1–4 weeks in a short outpatient visit.
Beyond the risks above, a smaller number of patients face more serious complications that affect kidney healing or function directly.
This is general educational information, not a personal risk assessment. Your own risk profile depends on your health, kidney function and stone complexity — discuss it directly with your urologist.
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
What to expect:
When to contact your doctor urgently:
Call your urology team right away if you notice:
If any of these feel like an emergency, seek emergency care immediately rather than waiting for a callback.
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Verified kidney centres linked to this treatment in the KidneyGlobal directory.
Yes, but rarely. It has been replaced as the default treatment by percutaneous nephrolithotomy (PCNL), ureteroscopy and shockwave lithotripsy. Surgeons now use it mainly for complex staghorn stones that other methods can't clear, or when a patient's anatomy or health makes keyhole surgery too risky.
Anatrophic nephrolithotomy is a specific, precise technique for open stone removal. "Open stone surgery" is the broader term and can also include simpler open procedures like pyelolithotomy or ureterolithotomy.
Some centers now perform anatrophic nephrolithotomy laparoscopically or with robotic assistance in carefully selected patients, which can mean a smaller incision. This isn't available everywhere and depends on surgeon experience and your anatomy.
Case series report stone-free rates of roughly 80–100%, generally higher than single sessions of shockwave lithotripsy or PCNL for the same type of complex, large staghorn stones — though direct comparisons depend heavily on stone complexity.
Yes. Any kidney stone treatment removes the existing stone but doesn't change your underlying tendency to form stones. Metabolic evaluation and prevention (fluid intake, diet, and sometimes medication) matter after any stone surgery.
Most patients need around 4–6 weeks before resuming normal activity, though desk-based work may be possible sooner and physically demanding work will take longer. Your surgeon will tailor this to your job and how your recovery is progressing.
