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Chou SF, Hsieh PF, Lin WC, Huang CP. Laparoscopic ureterolithotomy and retrograde flexible ureteroscopy-assisted transperitoneal laparoscopic ureteroureterostomy for a huge ureteropelvic junction stone and multiple small renal stones: A CARE-compliant case report. Medicine (Baltimore) 2021; 100:e26655. [PMID: 34260569 PMCID: PMC8284755 DOI: 10.1097/md.0000000000026655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Concurrent kidney and ureteral stones are always complicated and a clinical challenge. Improvements in endoscopic equipment have led to the widespread adoption of retrograde intrarenal surgery, which has a good stone clearance rate. On the other hand, laparoscopic ureterolithotomy (LUL) has been reported to be non-inferior to retrograde flexible ureteroscopy in stone-free rate and the need for axillary procedures, and to have a significantly lower rate of post-operative sepsis compared to retrograde flexible ureteroscopy. We describe a case managed with LUL followed by laparoscope-assisted retrograde intrarenal surgery (LA-RIRS) in a single operation for a large upper ureteral stone and small renal stones, which is usually challenging and requires axillary procedures. PATIENT CONCERNS The patient was a 66-year-old male with underlying hypertension and diabetes mellitus. He reported severe flank pain after receiving endoscopic management of concurrent right ureteropelvic junction stone and multiple renal stones about 1 month previously. DIAGNOSIS The residual stones were reassessed using non-contrast computed tomography before surgery. A 2.8-cm residual ureteropelvic junction stone and multiple renal stones with a maximum length of 1 cm were found. A second operation was considered to be necessary due to the deterioration of his renal function and refractory flank pain. INTERVENTIONS We performed LUL followed by LA-RIRS. Two surgeries were completed in a single operation. The Jackson-Pratt drain was removed 3 days after the operation. OUTCOMES After the surgery, no high-grade complications were recorded according to the Clavien Dindo classification. A follow-up kidney, ureter, and bladder radiograph performed 2 months after the operation revealed no residual stones. Renal echo revealed no obstructive nephropathy 1 month after double-J catheter removal. CONCLUSION LUL with LA-RIRS with a stone basket for renal stone extraction is a safe and feasible technique, and no step surgery or axillary procedures were needed in our case. If clinical cases with a huge stone burden over the ureter are indicated for LUL with concurrent small renal stones, LUL with LA-RIRS can be an alternative option.
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Affiliation(s)
- Sheng-Feng Chou
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Ching Lin
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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Kadihasanoglu M, Yucetas U, Karabay E, Sonmezay E. Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy. Int Braz J Urol 2019; 45:965-973. [PMID: 31626519 PMCID: PMC6844342 DOI: 10.1590/s1677-5538.ibju.2018.0781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/06/2019] [Indexed: 12/22/2022] Open
Abstract
Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.
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Affiliation(s)
| | - Ugur Yucetas
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
| | - Emre Karabay
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
| | - Erkan Sonmezay
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
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Nefrolitotomía retrógrada flexible láser en el manejo de la litiasis renal mayor de 2cm como alternativa a la nefrolitotomía percutánea. Rev Urol 2016. [DOI: 10.1016/j.uroco.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Neira Melo IM, Estrada Guerrero A, Celis Reyes E. Retrograde flexible nephrolithotomy in the management of large lithiasic masses as an alternative to percutaneous nephrolithotomy. UROLOGÍA COLOMBIANA 2016. [DOI: 10.1016/j.uroco.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zhao C, Yang H, Tang K, Xia D, Xu H, Chen Z, Ye Z. Comparison of laparoscopic stone surgery and percutaneous nephrolithotomy in the management of large upper urinary stones: a meta-analysis. Urolithiasis 2016; 44:479-490. [PMID: 26936378 DOI: 10.1007/s00240-016-0862-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/08/2016] [Indexed: 12/30/2022]
Abstract
For the treatment of large upper urinary stones percutaneous nephrolithotomy (PCNL) is generally considered the first choice, and Laparoscopic Stone Surgery (LSS) is an alternative. We aim to compare the efficiency and safety of PCNL with LSS, as far as the management of large upper urinary stones is concerned. A systematic search from Pubmed, Web of Science, Wiley Online Library and Elsevier was performed up to August 1, 2015 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.3 software. 15 eligible trials evaluating LSS vs. PCNL were identified including 6 prospective and 9 retrospective studies with 473 patients undergoing LSS and 523 patients undergoing PCNL. Although LSS led to longer operative time (p = 0.01) and higher open conversion rate (p = 0.02), patients might benefit from significantly fewer overall complications (p = 0.03), especially lower bleeding rate (p = 0.02), smaller drop in hemoglobin level (p < 0.001), less need of blood transfusion (p = 0.01). The stone free rate was also higher for LSS compared with PCNL (p < 0.001) with less secondary/complementary procedure (p = 0.006). There was no significant difference in other demographic parameters between the two groups. Our data suggests that LSS turns out to be a safe and feasible alternative to PCNL for large upper urinary stones with less bleeding and higher stone free rate. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric studies and randomized control trials should be undertaken to confirm our findings.
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Affiliation(s)
- Chenming Zhao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Fahmy O, El-Fayoumi AR, Gakis G, Amend B, Khairul-Asri MG, Stenzl A, Schwentner C. Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study. Cent European J Urol 2016; 68:466-70. [PMID: 26855804 PMCID: PMC4742439 DOI: 10.5173/ceju.2015.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/27/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Laparoscopic pyeloplasty is considered a standard treatment for ureteropelvic junction obstruction (UPJO). However, the presence of another pathology makes it a more challenging operation and guides the surgeon towards open conversion. In this study, we present our experience in difficult pyeloplasty cases managed by laparoscopy. Material and methods Six patients (4 females and 2 males) with an average age of 44 and a range of 27 to 60 years old, were diagnosed for UPJO. Three were on the left side and 3 on the right side. In addition to UPJO, 2 patients had renal stones, one patient had both renal ptosis and an umbilical hernia, 3 patients had a para-pelvic cyst, hepatomegaly and malrotated kidney, respectively. All patients had a preoperative ultrasound, CT or IVU, and a renal isotope scan. Laparoscopic pyeloplasty was performed according to the dismembered Anderson-Hynes technique with auxiliary maneuver, according to the pathology. Results All patients were treated successfully for UPJO and the concomitant pathologies, except hepatomegaly and malrotation. Mean operative time was 125 minutes and estimated blood loss was <50 ml. Conclusions Laparoscopic pyeloplasty can be performed in difficult situations provided that the surgeon has enough experience with laparoscopy.
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Affiliation(s)
- Omar Fahmy
- Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany
| | | | - Georgios Gakis
- Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany
| | - Bastian Amend
- Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany
| | | | - Arnulf Stenzl
- Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany
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Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis 2015; 43:5-12. [PMID: 25362543 DOI: 10.1007/s00240-014-0736-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 12/20/2022]
Abstract
The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.
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Affiliation(s)
- Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
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Lee JW, Cho SY, Jeong CW, Yu J, Son H, Jeong H, Oh SJ, Kim HH, Lee SB. Comparison of Surgical Outcomes Between Laparoscopic Pyelolithotomy and Percutaneous Nephrolithotomy in Patients with Multiple Renal Stones in Various Parts of the Pelvocalyceal System. J Laparoendosc Adv Surg Tech A 2014; 24:634-9. [DOI: 10.1089/lap.2014.0046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Jeong Woo Lee
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Sung Yong Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jihyeong Yu
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Bae Lee
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Jung JH, Cho SY, Jeong CW, Jeong H, Son H, Woo SH, Kim DK, Min SH, Oh SJ, Kim HH, Lee SB. Laparoscopic stone surgery with the aid of flexible nephroscopy. Korean J Urol 2014; 55:475-81. [PMID: 25045447 PMCID: PMC4101118 DOI: 10.4111/kju.2014.55.7.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 06/16/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. Materials and Methods A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. Results The patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. Conclusions Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.
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Affiliation(s)
- Jae Hyun Jung
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seung Hyo Woo
- Department of Urology, Eulji University School of Medicine, Daejeon, Korea
| | - Dae Kyung Kim
- Department of Urology, Eulji University School of Medicine, Daejeon, Korea
| | - Sun-Ho Min
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon-Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung Bae Lee
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Naitoh Y, Kawauchi A, Kamoi K, Soh J, Hongo F, Okihara K, Miki T. Nephrolithotomy Performed Concurrently With Laparoendoscopic Single-site Pyeloplasty. Urology 2014; 83:243-6. [DOI: 10.1016/j.urology.2013.08.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Singh V, Sinha RJ, Gupta DK, Pandey M. Prospective Randomized Comparison of Retroperitoneoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy for Solitary Large Pelvic Kidney Stones. Urol Int 2013; 92:392-5. [DOI: 10.1159/000353973] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022]
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12
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Haggag YM, Morsy G, Badr MM, Al Emam ABA, Farid M, Etafy M. Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones. Can Urol Assoc J 2013; 7:E171-5. [PMID: 23589752 PMCID: PMC3612403 DOI: 10.5489/cuaj.490] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL). METHODS This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm(2) or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed. RESULTS There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 ± 12.25 [range: 52.75-77.25] vs. 180 ± 20.74 [range: 159.26-200.74] mL, p ≤ 0001), mean hospital stay (2.3 ± 0.64 [range: 1.66-2.94] vs. 3.7 ± 1.4 [range: 2.3-5.1] days, p ≤ 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ≤ 0.0024), and stone-free rate (80% vs. 78.6%, p ≤ 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 ± 22.11 [range: 108.89-153.11) vs. 51.19 ± 24.39 [range: 26.8-75.58] min, p ≤ 0001), respectively. CONCLUSION Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones.
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Tepeler A, Silay MS, Armagan A, Basibuyuk I, Akman T, Akcay M, Onol SY. Laparoscopic-assisted "microperc" of a stone in a pelvic kidney of a 3-year-old girl. J Laparoendosc Adv Surg Tech A 2012; 23:174-6. [PMID: 23157323 DOI: 10.1089/lap.2012.0270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Treatment of kidney stones in pelvic ectopic kidneys of children is a challenging procedure for urologists. Herein we report a case of laparoscopy-assisted "microperc" in a 3-year-old girl with a stone in her pelvic ectopic kidney. This micro-optical system is helpful in confirming the percutaneous access and provides the possibility of fragmenting the stone without the necessity of dilating the tract.
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Affiliation(s)
- Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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Zacchero M, Volpe A, Billia M, Tarabuzzi R, Varvello F, De Angelis P, De Lorenzis E, Mittino I, Terrone C. Transmesenteric approach for left transperitoneal renal surgery: technique and experience. J Laparoendosc Adv Surg Tech A 2012; 22:176-9. [PMID: 22216968 DOI: 10.1089/lap.2011.0395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In the last few years laparoscopic surgery has become the gold standard for the treatment of several urological diseases such as renal cancer and ureteropelvic junction obstruction (UPJO). A transmesenteric approach for left laparoscopic pyeloplasty has been recently described in order to avoid bowel manipulation and the potentially related complications. The aim of the present study is to describe the surgical technique and the advantages of the transmesenteric approach for laparoscopic pyeloplasty, pyelolithotomy, and simple nephrectomy in our experience. SUBJECTS AND METHODS From December 2007 to May 2010, 12 laparoscopic procedures for left renal diseases were performed using a transmesenteric approach. The indications were left UPJO in 9 cases, left pelvic-ureteral stones in 2 cases, and left end-stage kidney disease in one case. RESULTS No conversions or intraoperative complications were observed. No blood transfusions were required. Resumption of oral intake and canalization occurred in all cases within 48 hours of the procedure. All patients had an uneventful postoperative course. CONCLUSIONS The laparoscopic transmesenteric approach represents an interesting and advantageous technical improvement of minimally invasive surgery for the treatment of left renal diseases.
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Affiliation(s)
- Monica Zacchero
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
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Chander J, Gupta N, Lal P, Lal P, Ramteke VK. Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones. J Minim Access Surg 2011; 6:106-10. [PMID: 21120067 PMCID: PMC2992658 DOI: 10.4103/0972-9941.72596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 07/01/2010] [Indexed: 11/24/2022] Open
Abstract
AIM: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL) and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. MATERIALS AND METHODS: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL) group and 82 cases in the shock wave lithotripsy (SWL) group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. RESULTS: The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. CONCLUSIONS: Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.
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Affiliation(s)
- Jagdish Chander
- Department of Surgery, Maulana Azad Medical College, New Delhi - 110 002, India
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Al-Hunayan A, Khalil M, Hassabo M, Hanafi A, Abdul-Halim H. Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy. J Endourol 2011; 25:975-8. [PMID: 21612433 DOI: 10.1089/end.2010.0467] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous nephrolithotomy (PCNL) is considered the main management option for large single renal pelvic stones; however, laparoscopic retroperitoneal pyelolithotomy (LRP) can be used as an alternative management procedure. We compare both procedures in the management of solitary large renal pelvic stones. PATIENTS AND METHODS Between June 2002 and July 2010, 105 patients with solitary large renal pelvic stones were selected and randomly divided into two groups; group 1 included 55 patients who were treated by LRP and group 2 included 50 patients who were treated by PCNL. The differences between the two procedures were compared and analyzed. RESULTS There was no difference between the two groups regarding patient demographics and stone size. There was no statistically significant difference between LRP and PCNL regarding mean estimated blood loss (166.4±98.3 mL vs 178±102.4 mL), mean hospital stay (4.5±1.9 d, vs 4.4±1.4 d), mean time of postoperative analgesia (2.2±0.9 d vs 2.4±0.9 d), rate of postoperative blood transfusion (5.5% vs 6%), and stone-free rate (100% vs 96%). The mean operative time was significantly longer in the LRP group (130.6±38.7 min vs 108.5±18.7 min), respectively. There was only one (1.8%) case from the laparoscopy group converted to open surgery because of uncontrolled bleeding. CONCLUSION RLP is a suitable surgical technique for patients with large renal pelvic stones but with good selection of cases; however, PCNL remains the standard treatment in most cases.
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Affiliation(s)
- Adel Al-Hunayan
- Department of Surgery (Division of Urology), Kuwait University, Kuwait, Kuwait.
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Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: an updated evidence-based review. ACTA ACUST UNITED AC 2010; 38:337-44. [DOI: 10.1007/s00240-010-0275-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/06/2010] [Indexed: 11/24/2022]
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Micali S, Pini G, Sighinolfi MC, De Stefani S, Annino F, Bianchi G. Laparoscopic Simultaneous Treatment of Peripelvic Renal Cysts and Stones: Case Series. J Endourol 2009; 23:1851-6. [DOI: 10.1089/end.2009.0042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovannalberto Pini
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano De Stefani
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Annino
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Salvadó JA, Guzmán S, Trucco CA, Parra CA. Laparoscopic pyelolithotomy: optimizing surgical technique. J Endourol 2009; 23:575-8; discussion 578. [PMID: 19358685 DOI: 10.1089/end.2008.0582] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The classic approach to renal stone disease includes shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy, and, in some cases, a combination of both. The usefulness of laparoscopy in this regard remains debated. In this report and video, we present our technique of laparoscopic pyelolithotomy assisted by flexible instrumentation to achieve maximal stone clearance in a selected group of patients.
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Affiliation(s)
- José A Salvadó
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Charalambous S, Printza N, Papathanasiou A, Rombis V, Goga C, Papachristou F. Shockwave lithotripsy and endourological management of urinary calculi in children: a single-center 10-year experience. J Endourol 2008; 22:2169-74. [PMID: 18811575 DOI: 10.1089/end.2008.0044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Shock wave lithotripsy (SWL) and endourological techniques revolutionized the management of pediatric urolithiasis. We sought to assess the impact of new technology and local practice in the treatment of pediatric urolithiasis during a 10-year period. MATERIALS AND METHODS Between 1997 and 2006, 125 children (90 boys and 35 girls), aged 18 months to 15 years, were managed in our department for urolithiasis. Stone localization, stone composition, presence of anatomic abnormalities, and treatment modality were evaluated retrospectively. RESULTS In 102 children, the stone was located in renal pelvis (0.5-45-mm diameter), in eight in the renal pelvis and one in the calyx; three had staghorn calculi; and 12 had ureteral stone (4-12-mm diameter). Ninety-three of 125 children underwent a total of 108 SWL sessions. Stone size ranged from 0.5 to 35 mm. The stone-free rates were 86%, 92%, and 96% after first, second, and third SWL session, respectively. Ureteroscopy was performed in 12/125 children, and 10/12 (83.5%) were rendered stone free. Nine of 125 children underwent percutaneous nephrolithotomy, and four of nine were stone free (44.5%), although five of the nine children (55.5%) required SWL for residual stone fragments. Open surgery was performed as initial procedure in 11 (9%) children. In 9 of 11 children, ureteropelvic junction obstruction was corrected simultaneously. Open surgery was followed by SWL in 3 of 11 patients. Two of three patients with staghorn calculi underwent nephrolithotomy and SWL and one of three with cysteinuria was managed with SWL. CONCLUSIONS SWL and endourological techniques are safe and effective in managing urolithiasis in pediatric patients. These minimally invasive methods reduced dramatically the cases of open surgery, which should be undertaken mainly in coexisting anatomic abnormalities.
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Affiliation(s)
- S Charalambous
- Urological Department, Hippokration General Hospital, Thessaloniki, Greece
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