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The term pyelo defines renal pelvis, & the term lithotomy was called as removal of stone. Pyelolithotomy have a major part in the organization of renal pelvic stones in the areas where ESWL & PNL were not feasible due the lack of the equipment or the expertise of the doctor. Indications for the pyelolithotomy will comprise minimally branched staghorn stones in renal pelvis of complex collecting systems & excessive morbid obesity. Pyelolithotomy was also suitable in the patients who are about to undergo the major open abdominal or retroperitoneal surgical methods for other indications; the most common concomitant method was open pyeloplasty for the ureteropelvic junction (UPJ) obstruction.

PROCEDURE OF PYELOLITHOTOMY:

The renal pelvis was opened, & the ureter will be probed for the stones or structures by passing the ureteral catheter & irrigating.
Stones were then removed. A multieyed catheter- Foley type, Pezzer or Malecot was placed. The catheter was protected with the sutures.
A purse-string suture can be placed surrounding the nephrostomy tube. After the removal of a staghorn calculus, mattress sutures is generally tied above the pad of renal fat to support the long parenchymal cut or incision.
Post operative care should be taken such as X ray KUB was required to confirm the complete clearance of the calculi. Biochemical analysis of the stone needs to be performed. The drains were removed after 24-48 hrs when the surgery was done.

Pyelolithotomy is the open surgical method in the cases involving a stone in renal pelvis. This will be a common technique till the improvement of extracorporeal shockwave treatment, PNL, and ureteroscopic laser lithotripsy. However, pyelolithotomy continues to be performed when other modalities fail or when proper facilities are unavailable.

Complications like bleeding, recurrent stones, stone migration, hemorrhage, urinary fistula, and actual orF functional loss of the renal unit, infections may also cause. Stone free rates in the patients who are undergoing pyelolithotomy were variable, based on the number of stones, the composition of the stone, & the existence of stones or obstruction.

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