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Krings G, Ayoub E, Campi R, Rouprêt M, Vaessen C, Parra J, Mozer P. Ureteropelvic junction obstruction and renal calculi: Simultaneous treatment by robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy. Technique description and early outcomes. Prog Urol 2023; 33:279-284. [PMID: 36792487 DOI: 10.1016/j.purol.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) and renal calculi are associated in 20 to 30% of cases and treatment is mandatory. The simultaneous surgical management is a therapeutic challenge that is still a source of controversy. We describe our technique combining robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy (fURS), assessing the feasibility of simultaneous treatment through an original technique. METHODS This single centre series reports our initial experience with 12 patients. From January 2014 to September 2018, 12 patients underwent robot-assisted laparoscopic pyeloplasty with simultaneous fURS for UPJO and renal calculi. Mean age was 46 years (24-68). 92% had multiple renal stones and the mean cumulative stone diameter was 31,3mm. Robot-assisted pyeloplasty was performed with peroperative transcutaneous retrograde fURS through a ureteral access sheath introduced in an incision on the bassinet through a subcostal trocar. Stone extraction was performed using a basket. RESULTS All patients underwent surgery successfully, achieving UPJ repair and complete stone extraction. Mean operating time was 92,5min (85-110). All reported Clavien-Dindo complications were grade 1. Non-contrast enhanced abdominal CT performed 1 month after surgery confirmed the absence of residual stones in all patients. Mean follow-up time was 10 months with no recurrence of UPJO. CONCLUSION This small series confirms the feasibility with good surgical results of concomitant robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde fURS stone extraction. No major complications were observed. This technique is easily reproducible but requires 2 experienced urologists to be achieved in a contained operative time.
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Affiliation(s)
- G Krings
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Urology Department, CHU UCL Namur, 1 Av Gaston Therasse, 5530 Yvoir, Belgium.
| | - E Ayoub
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - R Campi
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Department of Urology, University of Florence, Careggi Hospital, Urology, Florence, Italy..
| | - M Rouprêt
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France.
| | - C Vaessen
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - J Parra
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - P Mozer
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Sorbonne Université, Institut des Systèmes Intelligents et de Robotique (ISIR) UPMC - CNRS/UMR 7222, 75005 Paris, France.
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Scarcella S, Tiroli M, Torino G, Mariscoli F, Cobellis G, Galosi AB. Combined treatment of ureteropelvic junction obstruction and renal calculi with robot-assisted laparoscopic pyeloplasty and laser lithotripsy in children: Case report and non-systematic review of the literature. Int J Med Robot 2021; 17:e2246. [PMID: 33626232 DOI: 10.1002/rcs.2246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE(S) The incidence of urinary tract stone disease is steadily increasing in both adult and paediatric populations. This condition develops due to different factors: dietary or metabolic alterations, infection, and congenital anatomic malformations. Standard indications and treatments for children are analogous to the ones indicated for adults. Extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy (PCNL) should be preferred to more invasive techniques. Moreover, the introduction of laparoscopic and robot-assisted laparoscopic approaches have improved surgical outcomes, lowering the bleeding risk with higher stone-free rates, even in complicated cases. Despite these well-known improvements, there are few reports regarding laparoscopic robot-assisted management for urinary tract stone disease in paediatric patients under the age of 10, especially with concomitant treatment of ureteropelvic junction obstruction and multiple calyceal stones. PATIENT AND METHOD(S) A 4-year-old child was referred for recurrent right abdominal flank pain, macroscopic haematuria and a previous history of urinary tract infections. A computed tomography of the abdomen showed right ureteropelvic junction obstruction associated with multiple unilateral stones located in the renal pelvis and in the interpolar renal calyces. Due to its complexity, we held a multidisciplinary meeting with paediatric surgeons and nephrologists to determine optimal treatment. As a result, a combined robot-assisted laparoscopic pyeloplasty (LP) and renal calculi holmium laser lithotripsy using a digital flexible ureteroscope through an abdominal robotic trocar was performed. No post-surgical complications were recorded, and the patient was discharged within 48 h following surgery. At subsequent regular follow-up examinations over a period of 24 months, no signs of recurrence were detected for both ureteropelvic junction obstruction and stone disease. RESULT(S) Robot-assisted LP with concomitant laser lithotripsy is a reasonable treatment option for designated young paediatric patients with challenging ureteropelvic junction obstruction complicated by urolithiasis, especially in cases where stones are not amenable with standard procedures.
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Affiliation(s)
- Simone Scarcella
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Marco Tiroli
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Giovanni Torino
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Francesca Mariscoli
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
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Chen X, Wang Y, Gao L, Song J, Wang JY, Wang DD, Ma JX, Zhang ZQ, Bi LK, Xie DD, Yu DX. Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys. World J Clin Cases 2020; 8:4753-4762. [PMID: 33195643 PMCID: PMC7642540 DOI: 10.12998/wjcc.v8.i20.4753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.
AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.
METHODS This was a retrospective study of 12 patients with HK and a limited number (n ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).
RESULTS No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min vs 151.40 ± 39.54 min, P = 0.399), estimated blood loss (48.57 ± 31.85 mL vs 72.00 ± 41.47 mL, P = 0.292) and length of hospital stay (12.14 ± 2.61 d vs 12.40 ± 3.21 d, P = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m2), respectively (P = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m2), respectively (P = 0.581).
CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Jin Song
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jin-You Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Deng-Dian Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jia-Xing Ma
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Zhi-Qiang Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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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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5
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Outcomes and peri-operative complications of robotic pyelolithotomy. J Robot Surg 2019; 14:401-407. [DOI: 10.1007/s11701-019-01004-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/15/2019] [Indexed: 12/23/2022]
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Shi B, Hong X, Yu J. Management of unilateral staghorn renal stones with concurrent urinary tract infections by retroperitoneal laparoscopic pyelolithotomy with prolonged renal posterior lower segment incision. Exp Ther Med 2019; 18:366-372. [PMID: 31258674 PMCID: PMC6566088 DOI: 10.3892/etm.2019.7545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/05/2019] [Indexed: 12/12/2022] Open
Abstract
The present study evaluated the effectiveness and safety of the removal of unilateral staghorn renal stones with concurrent infections by retroperitoneal laparoscopic pyelolithotomy (RLP) with prolonged renal posterior lower segment incision. Patients with staghorn renal stone and concurrent urinary tract infection (UTI) who underwent RLP with prolonged renal posterior lower segment incision as the primary, one-session treatment at our institution between March 2014 and December 2017 were retrospectively reviewed. Routine laboratory tests were performed and the patients received broad-spectrum intravenous antibiotics from at least 3 days prior to the operation. All patients were examined pre-operatively by urinary ultrasonography, computed tomography or intravenous urography. UTI was confirmed by laboratory tests with or without radiographic evidence by an experienced urologist. All patients (18 females and 10 males) successfully underwent the procedures and there was no conversion to open surgery in any case. The mean age was 57.0±10.81 years (age range, 40–74 years) and the mean calculus size was 3.3±0.79 cm. The mean operation time, warm ischemia time and post-operative hospital stay were 114.4±12.09 min, 28.1±4.23 min and 5.8±1.42 days, respectively. The mean hemoglobin drop on day 3 following surgery was 0.5±0.38 g/dl and there was no requirement for blood transfusion in any patient. The mean change of serum creatinine levels between pre-operative baseline and post-operative day 3 or post-operative month 6 was 6.0±20.03 or −4.5±15.13 µmol/l, respectively. The stone-free rate was 100% at 3 days and at 6 months. Mild post-operative complications (Grade I or II) occurred in 6 patients, including temporary and constant elevated body temperature (>38.5°C). No severe complications, including urine leakage, sepsis, residual stones requiring auxiliary procedures, were noted and there were no circumstances requiring further surgical intervention in any of the patients. In conclusion, RLP with prolonged renal posterior lower segment incision is an effective and safe procedure for patients with staghorn renal stones and concurrent UTI, and its feasible application as a single-session monotherapy is particularly convenient considering the financial and medical situation, as well as the patients' preference.
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Affiliation(s)
- Bowen Shi
- Department of Urology, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Xi Hong
- Department of Urology, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Jianjun Yu
- Department of Urology, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
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7
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Cealan A, Coman RT, Simon V, Andras I, Telecan T, Coman I, Crisan N. Evaluation of the efficacy of Phyllanthus niruri standardized extract combined with magnesium and vitamin B6 for the treatment of patients with uncomplicated nephrolithiasis. Med Pharm Rep 2019; 92:153-157. [PMID: 31086843 PMCID: PMC6510356 DOI: 10.15386/mpr-1246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of our study was to assess the efficacy of Phyllanthus niruri standardized extract, combined with magnesium and B6 vitamin, used to treat uncomplicated nephrolithiasis. Methods We included in the present study 48 patients with uncomplicated nephrolithiasis, with the maximum calculi diameter of up to 15 mm, confirmed by non-contrast-enhanced computer tomography. Each patient followed a three-month therapeutic regimen with the above mentioned combination, with imaging assessment of the calculi after treatment. Results Per patient: The mean age of the patients was 48 years. The median number of calculi was 1 and the mean dimension was 5.5 mm. The stone-free status after treatment was not correlated with gender (p=0.7), side location (p=0.8) or with the number of calculi (p=0.3), but we found a correlation with the location in the upper or middle calyx (54.5% vs 13.8%, p=0.008) and with the maximum diameter (p=0.001).Per stone: 60 calculi were analyzed, 8.3% being located in the upper calyx, 36.7% in the middle and 55% in the lower one. After treatment, 40% were absent, 21.7% showed lower dimensions and 38.3% remained unchanged, with the mean reduction of 1.7 mm. We identified a cut-off value of ≤ 3 mm (AUC 0.9, CI:0.8-0.9, p<0.0001) for the prediction of stone-free status after treatment. Conclusions The current treatment had the highest efficacy in achieving stone-free status for patients with calculi ≤ 3 mm, located in the middle or upper calyx. A higher duration of the treatment might show improved results.
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Affiliation(s)
- Alexandru Cealan
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vasile Simon
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Telecan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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8
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Adam A, Reddy D. "Vaginal Delivery": A Novel Extraction Route for Large Renal Calculi Encountered During Laparoscopic Pyeloplasty. Curr Urol 2019; 12:104-110. [PMID: 31114468 DOI: 10.1159/000489427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy. Methods After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed. Results The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups. Conclusions This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.
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Affiliation(s)
- Ahmed Adam
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Johannesburg, South Africa.,Wits Donald Gordon Medical Centre, Johannesburg, South Africa.,Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Deshin Reddy
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Johannesburg, South Africa
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Perioperative and long-term results of retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for staghorn calculi: a single-center randomized controlled trial. World J Urol 2018; 37:1441-1447. [PMID: 30361956 DOI: 10.1007/s00345-018-2526-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi. METHODS From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups. RESULTS Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months. CONCLUSIONS PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.
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10
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Jensen PH, Berg KD, Azawi NH. Robot-assisted pyeloplasty and pyelolithotomy in patients with ureteropelvic junction stenosis. Scand J Urol 2017; 51:323-328. [PMID: 28398101 DOI: 10.1080/21681805.2017.1300188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Approximately one in five patients with ureteropelvic junction stenosis (UPJS) also present with renal or ureteral stones. For patients with UPJS, the European Association of Urology guidelines currently recommend that robot-assisted pyeloplasty (RAP) and pyelolithotomy are performed as two separate procedures. The aim of the present study was to evaluate the feasibility and safety of RAP with concomitant pyelolithotomy (RAP + P) in patients diagnosed with UPJS and renal stones. MATERIALS AND METHODS In total, 56 RAP procedures and 18 RAP + P procedures were performed between December 2012 and January 2014. Patient records were retrospectively reviewed for operation time (OT), estimated blood loss (EBL), length of hospital stay (LOS), complications, stone burden and stone-free rates at 1, 3 and 6 months following surgery. RESULTS A significant difference in the OT was demonstrated between RAP and RAP + P, with a median of 120 min [interquartile range (IQR) 100-134 min] and 151 min (IQR 128-185 min), respectively (p < 0.0001). In contrast, no difference in LOS [median 2 days (IQR 2-3 days) vs 3 days (2-4 days), p = 0.50) or EBL [median 0 ml (IQR 0-50 ml) vs 20 ml (0-50 ml), p = 0.64] was observed between RAP and RAP + P. The median total stone burden was 1.5 cm (IQR 1.0-4.3 cm; range 1-10 cm). The stone-free rate at 1, 3 and 6 months was 94%, 83% and 72%, respectively. No grade 3-5 complications were observed in the RAP + P group. CONCLUSIONS RAP + P can safely be offered to patients with UPJS and renal stones, with an acceptable stone-free rate.
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Affiliation(s)
| | - Kasper Drimer Berg
- a Department of Urology , Zealand University Hospital , Roskilde , Denmark
| | - Nessn H Azawi
- a Department of Urology , Zealand University Hospital , Roskilde , Denmark
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11
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Hasan R, Gribbin C, Hutton R, Amer T, Little B, Meddings R. A successful case of a laparoscopic extraction with closure of the diverticulum for an anteriorly placed calculus in an infundibular diverticulum. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415814553651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Hasan
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - C Gribbin
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - R Hutton
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - T Amer
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - B Little
- Urology department, University Hospital Ayr, South Ayrshire, UK
| | - R Meddings
- Urology department, University Hospital Ayr, South Ayrshire, UK
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12
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Nottingham CU, Cohen AJ, Packiam VT, Pariser JJ, Gerber GS. Hospital-Based Analysis of Trends and Outcomes for Patients Undergoing Pyelolithotomy. J Endourol 2016; 31:78-84. [PMID: 27784168 DOI: 10.1089/end.2016.0672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine trends in pyelolithotomy, evaluate risk factors for complications, and evaluate the difference in outcomes and charges between open and minimally invasive (MI) techniques. PATIENTS AND METHODS We used the Nationwide Inpatient Sample to identify patients with a diagnosis of having nephrolithiasis undergoing pyelolithotomy from 2008 to 2012. Total charges were inflation-adjusted to U.S. dollars in 2012. Patient demographics, hospital characteristics, and outcomes were reported and compared between open and MI groups after survey weighting. RESULTS We included a survey-weighted population of 17,294 patients, of whom 841 (4.9%) had MI pyelolithotomy. The proportion of MI cases increased by 2.57% annually (r2 = 0.921, p = 0.01), although total pyelolithotomy cases remained stable. Simultaneous pyeloplasty occurred in 6.6% of all patients. Patients receiving open surgery experienced longer length of stay (3.9 days vs 2.7 days; p < 0.001), but accrued equivalent inflation-adjusted charges ($49,588 ± 2088 vs $51,716 ± 4893; p = 0.665). On multivariable analysis, higher Elixhauser comorbidity index and presence of any genitourinary anomaly were associated with experiencing a complication, while undergoing surgery at a top quartile hospital and elective admission status were protective against complications. MI technique and simultaneous ureteropelvic junction repair did not alter complication risk. CONCLUSION While the annual number of pyelolithotomy cases was stable, there was an increasing trend toward MI technique. Both patient and hospital factors can significantly alter the risk for complications following pyelolithotomy.
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Affiliation(s)
- Charles U Nottingham
- Department of Surgery, Section of Urology, University of Chicago Medicine , Chicago, Illinois
| | - Andrew J Cohen
- Department of Surgery, Section of Urology, University of Chicago Medicine , Chicago, Illinois
| | - Vignesh T Packiam
- Department of Surgery, Section of Urology, University of Chicago Medicine , Chicago, Illinois
| | - Joseph J Pariser
- Department of Surgery, Section of Urology, University of Chicago Medicine , Chicago, Illinois
| | - Glenn S Gerber
- Department of Surgery, Section of Urology, University of Chicago Medicine , Chicago, Illinois
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Fragoso AC, Steyaert H, Arnaud P, Esposito C, Estevao-Costa J, Valla JS. Minimal access surgery in the management of pediatric urolithiasis. Transl Pediatr 2016; 5:262-265. [PMID: 27867850 PMCID: PMC5107375 DOI: 10.21037/tp.2016.09.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In contrast to adult patients, a relatively large number of open surgical procedures are still needed in the treatment of urolithiasis in children. Since almost all open surgical techniques may be reproduced by minimal access surgery (MAS), there is a rationale to apply the latter in the management of pediatric urolithiasis. Our study aimed to assess the feasibility and outcome of MAS in the treatment of pediatric urinary calculi. METHODS The charts of patients with urolithiasis submitted to MAS between 1994 and 2007 were retrospectively reviewed. The inclusion criteria were contraindication for and failure of lithotripsy or endourology techniques. Demographic data, lithiasis characterization (location, dimension, composition), predisposing factors (anatomic or metabolic) and surgical approach (technique and outcome) were evaluated. RESULTS Fifteen consecutive patients (eight girls, seven boys) with a median age of 108 months (range: 10-297 months) were elected for MAS. Eleven (73%) children had associated urogenital malformations and three (20%) presented metabolic abnormalities. A total of 17 procedures were performed laparoscopically: three nephrolithotomy (one transperitoneal, two by retroperitoneoscopy), four pyelolithotomies (retro), three ureterolithotomy (trans) and seven cystolithotomies (suprapubic approach). Five patients underwent concomitant correction of urological anomalies (three calyceal diverticula, one obstructive megaureter, one ureteropelvic junction obstruction). Complete removal of calculi was accomplished in 14 (82%) procedures. There were two perioperative complications (one intraperitoneal vesical perforation and one perivesical urinoma). At a median follow up of 4 years (range, 1 month to 11 years), four patients have developed recurrence. CONCLUSIONS MAS is an effective and safe approach for urolithiasis in children who are not candidates for minimally invasive modalities.
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Affiliation(s)
- Ana Catarina Fragoso
- Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. Joa˜o, 4200-319 Porto, Portugal
| | - Henry Steyaert
- Department of Pediatric Surgery, Hospital Lenval, Nice, France
| | - Pierre Arnaud
- Department of Pediatric Surgery, Hospital Lenval, Nice, France
| | - Ciro Esposito
- Department of Pediatrics, Pediatric Surgery, ''Frederico II'' University of Naples, School of Medicine, Naples, Italy
| | - Jose Estevao-Costa
- Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. Joa˜o, 4200-319 Porto, Portugal
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Pastore AL, Palleschi G, Silvestri L, Leto A, Ripoli A, Fuschi A, Al Salhi Y, Autieri D, Petrozza V, Carbone A. Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series. Ther Adv Urol 2016; 8:3-8. [PMID: 26834835 DOI: 10.1177/1756287215607417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. METHODS From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2-9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. RESULTS The average operative time was 140 min (range, 90-190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5-0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2-6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. CONCLUSIONS Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75-100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons.
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Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy
| | - Giovanni Palleschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonino Leto
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Ripoli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Domenico Autieri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
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Ölçücüoğlu E, Çamtosun A, Biçer S, Bayraktar AM. Laparoscopic pyelolithotomy in a horseshoe kidney. Turk J Urol 2015; 40:240-4. [PMID: 26328185 DOI: 10.5152/tud.2014.73604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 11/22/2022]
Abstract
The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and a male to female ratio of 2:1. In this article we aimed to report a 50-year-old man who had left kidney stones accompanied with a horseshoe kidney. In this case percutaneous nephrolithotomy was deemed to be a risky procedure due to malrotation of the pelviocalyceal system and possible interposition of bowel loops between kidney and the abdominal wall. Therefore, we preferred laparoscopic pyelolithotomy. At the end of the procedure, the patient was stone-free. We observed no complication. The patient was discharged after 72 hours. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney.
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Affiliation(s)
- Erkan Ölçücüoğlu
- Department of Urology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Ahmet Çamtosun
- Department of Urology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Sait Biçer
- Department of Urology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
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16
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The role of open and laparoscopic stone surgery in the modern era of endourology. Nat Rev Urol 2015; 12:392-400. [DOI: 10.1038/nrurol.2015.141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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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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18
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Stravodimos KG, Giannakopoulos S, Tyritzis SI, Alevizopoulos A, Papadoukakis S, Touloupidis S, Constantinides CA. Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature. Res Rep Urol 2014; 6:43-50. [PMID: 24892032 PMCID: PMC4036597 DOI: 10.2147/rru.s59444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Approximately one out of five patients with ureteropelvic junction obstruction (UPJO) present lithiasis in the same setting. We present our outcomes of simultaneous laparoscopic management of UPJO and pelvic or calyceal lithiasis and review the current literature. Methods Thirteen patients, with a mean age of 42.8±13.3 years were diagnosed with UPJO and pelvic or calyceal lithiasis. All patients were subjected to laparoscopic dismembered Hynes–Anderson pyeloplasty along with removal of single or multiple stones, using a combination of laparoscopic graspers, irrigation, and flexible nephroscopy with nitinol baskets. Results The mean operative time was 218.8±66 minutes. In two cases, transposition of the ureter due to crossing vessels was performed. The mean diameter of the largest stone was 0.87±0.25 cm and the mean number of stones retrieved was 8.2 (1–32). Eleven out of 13 patients (84.6%) were rendered stone-free. Complications included prolonged urine output from the drain in one case (Clavien grade I) and urinoma formation requiring drainage in another case (Clavien grade IIIa). The mean postoperative follow-up was 30.2 (7–51) months. No patient has experienced stone or UPJO recurrence. Conclusion Laparoscopy for the management of UPJO along with renal stone removal seems a very appealing treatment, with all the advantages of minimally invasive surgery. Concomitant renal stones do not affect the outcome of laparoscopic pyeloplasty, at least in the midterm. According to our results and the latest literature data, we advocate laparoscopic management as the treatment of choice for these cases.
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Affiliation(s)
| | | | - Stavros I Tyritzis
- Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece
| | | | - Stefanos Papadoukakis
- Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece
| | - Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
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19
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Abstract
The natural course of untreated asymptomatic caliceal calculi has not been clearly defined, especially in terms of disease progression, and the indications for and outcomes of surgical intervention are not precise. Caliceal stones may remain asymptomatic but, in case of migration, ureteral calculi can cause acute ureteric colic with severe complications. The decision for an active treatment of caliceal calculi is based on stone composition, stone size and symptoms. Extracorporal shock-wave lithotripsy (ESWL) has a low complication rate and is recommended by the current guidelines of the European Association of Urology as a first-line therapy for the treatment of caliceal stones <2 cm in diameter. However, immediate stone removal is not achieved with ESWL. The primary stone-free rates (SFR) after ESWL depend on stone site and composition and, especially for lower pole calculi, the SFR differ widely from other caliceal stones. Minimally-invasive procedures including percutaneous nephrolithotomy and ureteroscopy are alternatives for the treatment of caliceal stones, associated with low morbidity and high primary SFR when performed in centers of excellence.
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Affiliation(s)
- Andreas J Gross
- Department of Urology, Asklepios Hospital Barmbek, 22291 Hamburg, Germany
| | - Sophie Knipper
- Department of Urology, Asklepios Hospital Barmbek, 22291 Hamburg, Germany
| | - Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, 22291 Hamburg, Germany
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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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21
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Myint M, Luke S, Louie-Johnsun M. Laparoscopic pyelolithotomy and pyeloplasty in a horseshoe kidney. ANZ J Surg 2013; 85:492-3. [PMID: 24251980 DOI: 10.1111/ans.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Michael Myint
- Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Serge Luke
- Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Mark Louie-Johnsun
- Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia
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Agrawal V, Bajaj J, Acharya H, Chanchalani R, Raina VK, Sharma D. Laparoscopic management of pediatric renal and ureteric stones. J Pediatr Urol 2013; 9:230-3. [PMID: 22498008 DOI: 10.1016/j.jpurol.2012.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones. METHOD Renal pelvic stones of size ≥1 cm on ultrasound were included for laparoscopic pyelolithotomy while smaller stones were managed with shock-wave lithotripsy monotherapy. Intrarenal stones, calyceal stones, complete staghorn stones, multiple stones and kidneys with intrarenal pelvis were excluded. Ureteric stones included for laparoscopic ureterolithotomy were of size ≥1 cm in the upper, mid or lower ureter, and smaller stones not responding to non-operative treatment. RESULTS A total of 22 procedures were performed: 12 pyelolithotomies, and 8 lower and 2 upper ureterolithotomies. Complete removal of calculi was accomplished in 21 (95.45%) procedures. Complications associated with laparoscopic lithotomy included urinoma (4.54%), failure (4.54%) and omental prolapse (4.54%). CONCLUSION Laparoscopic lithotomy is safe and feasible in pediatric urolithiasis with pyelic and ureteric stones, with minimal complications and failure rate.
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Affiliation(s)
- Vikesh Agrawal
- Department of Surgery, NSCB Government Medical College, Jabalpur 482003, India.
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23
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Abstract
Stones in abnormal situations present a management conundrum to the urologist. Many of these situations are relatively rare and literature is scanty on the appropriate management. We review the current literature on the management of stones in the setting of pregnancy, calyceal diverticulum, urinary diversions, pelvic kidneys, transplant kidneys, autosomal dominant polycystic kidney disease, horseshoe kidneys, and other renal anomalies. The aims of treatment are complete stone-free status. The modality of treatment should be individualized to the size and location of stone and type of abnormal situation confronted.
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Affiliation(s)
- Yung K Tan
- Department of Urology, Columbia University Medical Center, New York, NY 10032, USA
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24
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Abstract
The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist's armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology.
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25
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Chen Z, Zhou P, Yang ZQ, Li Y, Luo YC, He Y, Li NN, Xie CQ, Lai C, Fang XL, Chen X. Transperitoneal mini-laparoscopic pyeloplasty and concomitant ureteroscopy-assisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones. PLoS One 2013; 8:e55026. [PMID: 23326607 PMCID: PMC3541340 DOI: 10.1371/journal.pone.0055026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To present our experience of combining transperitoneal mini-laparoscopic pyeloplasty (mini-LP) and concomitant ureteroscopy-assisted pyelolithotomy (U-P) for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session. METHODS Between May 2007 and December 2011, mini-LP and concomitant U-P was performed in nine patients with UPJO and ipsilateral renal caliceal stones. Stone location and burden were preoperatively assessed. After pyelotomy with appropriate length (about 4 mm), a 16-Fr catheter sheath replaced the uppermost or lowermost laparoscopic trocar and was introduced directly into the renal pelvis under the guidance of a guide wire and laparoscopic vision. A 7.5F rigid ureteroscopy passed through the catheter sheath into the plevis. Intracorporeal lithotripsy and/or pressure irrigation via a pump was used for caliceal stone removal. Subsequently, laparoscopic pyeloplasty was performed in a standard fashion. Postoperative imaging was assessed. RESULTS The calculi sizes ranged from 2 to 11 mm (mean, 7.1 mm) and an average of 3 stones per patient was removed (range, 1 to 6 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 210 minutes, and estimated blood loss was 20 mL. Mean hospital stay was 5 days (4-7). Stent was removed after 4-8 weeks. No intraoperative or postoperative complications were noted during a mean follow-up of 18.5 months (range, 6 to 24 months). CONCLUSIONS Mini-LP and concomitant U-P are simple and effective alternatives for the simultaneous management of UPJO complicated by coexisting ipsilateral renal caliceal stones.
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Affiliation(s)
- Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peng Zhou
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhong-Qing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan-Cheng Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Nan-Nan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao-Qun Xie
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chen Lai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Long Fang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Indication to open anatrophic nephrolithotomy in the twenty-first century: a case report. Case Rep Urol 2012; 2012:851020. [PMID: 23227418 PMCID: PMC3513730 DOI: 10.1155/2012/851020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/31/2012] [Indexed: 11/21/2022] Open
Abstract
Introduction. Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Nevertheless in our experience, open surgery still represents the treatment of choice in rare cases. Case Report. A 71-year-old morbidly obese female patient complaining about occasional left flank pain, and recurrent cystitis for many years, presented bilateral staghorn kidney stones. Comorbidities were obesity (BMI 36.2), hypertension, type II diabetes, and chronic obstructive pulmunary disease (COPD) hyperlipidemia. Due to these comorbidities, endoscopic and laparoscopic approaches were not indicated. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was 180 minutes. Blood loss was 500 cc. requiring one unit of packed red blood cells. Hospital stay was 7 days. The renal function was unaffected based on preoperative and postoperative serum creatinine levels. Stone-free status of the left kidney was confirmed after surgery with CT scan. Conclusions. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases. A discussion of the current indications in the twenty-first century is presented.
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Natalin RA, Lima FS, Pinheiro T, Vicari E, Ortiz V, Andreoni C, Landman J. The final stage of the laparoscopic procedure: exploring final steps. Int Braz J Urol 2012; 38:4-16. [DOI: 10.1590/s1677-55382012000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2011] [Indexed: 11/21/2022] Open
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Ganpule AP, Prashant J, Desai MR. Laparoscopic and robot-assisted surgery in the management of urinary lithiasis. Arab J Urol 2012; 10:32-9. [PMID: 26558002 PMCID: PMC4442910 DOI: 10.1016/j.aju.2011.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 01/19/2023] Open
Abstract
Objectives To review the current role of laparoscopy and robot-assisted laparoscopy for managing urinary lithiasis. Results The contemporary indications for laparoscopic stone management are: anatomical variations in location or shape of the kidney (pelvic kidney, horseshoe kidney and malrotated kidney); coexisting pathologies, e.g. pelvi-ureteric junction obstruction; and stones in a renal unit with lower ureteric obstruction. The laparoscopic approach allows the simultaneous management of both the pathologies. Symptomatic stones in diverticula not amenable to endourological intervention can be treated with laparoscopy. Large impacted pelvic and ureteric calculi with a functioning renal unit are an indication for laparoscopic ureterolithotomy or pyelolithotomy. This review of current reports suggests that in a selected group of patients with complex stone disease the laparoscopic approach offers good success rates with minimal complications. There are few reports of robotic procedures in stone disease but existing data suggest that it is feasible. Conclusion Laparoscopic surgery is effective for complex renal stones and offers excellent stone clearance rates with minimal morbidity. Laparoscopic surgery is complementary in managing these stones. Robot-assisted laparoscopic technique of urinary tract stone management is in its early stage of implementation and randomised trials that compare robot assisted outcomes with other minimally invasive techniques are needed.
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Affiliation(s)
| | - Jain Prashant
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh R Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Desai MR, Ganpule AP. Percutaneous Nephrolithotomy (PCNL). Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Patient Evaluation and Comparison of Stone-Removing Strategies in Pediatric Patients with Urinary Tract Stones. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Laparoscopic Transperitoneal Pyelolithotomy for Management of Staghorn Renal Calculi. J Laparoendosc Adv Surg Tech A 2012; 22:61-5. [DOI: 10.1089/lap.2011.0302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
To date, most cases of renal calculi have been managed with extracorporeal shockwave lithotripsy and endoscopic procedures. However, for complex renal stone conditions, these minimally invasive procedures may require multiple operative sessions. Open surgery is usually reserved as a salvage procedure, although it is invasive in nature. Laparoscopic treatment is well accepted in renal surgery. For stone disease, it can duplicate open surgical techniques such as pyelolithotomy, pyeloplasty, anatrophic nephrolithotomy, caliceal diverticulectomy and nephrectomy. Although the laparoscopic techniques for stone treatment are quite challenging, it is both feasible and safe. Laparoscopic treatment is a viable option for large renal stone treatment with an excellent stone-free rate, especially when patients require their stones to be treated within a single session. However, it is more invasive in nature than endourology procedures and so should be reserved as the last resort option for renal stone management in the modern endourology era.
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Affiliation(s)
- Kittinut Kijvikai
- Associate Professor, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Tungphyatai, Rajathevee, Bangkok 10400, Thailand
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Abstract
PURPOSE OF REVIEW Although most ureteral and urinary stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. RECENT FINDINGS Indications for open or laparoscopic stone surgery are anatomic abnormalities, such as horseshoe kidneys, malrotated kidneys, ureteropelvic junction obstruction with stones, or ectopic kidneys; symptomatic stones in diverticula; extremely large stones and all those situations in which conventional endourologic procedures and extracorporeal shock-wave lithotripsy are not available or were unsuccessful or in those conditions where laparoscopy offers a priori the best solution to an endourologic complex condition. SUMMARY Laparoscopic surgery is effective for complex urinary stones and allows adjunctive procedures. It complements other minimally invasive procedures, and a need for open surgery has strongly diminished.
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Zhou L, Xuan Q, Wu B, Xiao J, Dong X, Huang T, Chen H, Zhu Y, Wu K. Retroperitoneal laparoscopic anatrophic nephrolithotomy for large staghorn calculi. Int J Urol 2010; 18:126-9. [DOI: 10.1111/j.1442-2042.2010.02688.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Badalato GM, Hemal AK, Menon M, Badani KK. Current role of robot-assisted pyelolithotomy for the management of large renal calculi: a contemporary analysis. J Endourol 2009; 23:1719-22. [PMID: 19785554 DOI: 10.1089/end.2009.1540] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The scope of robot-assisted surgery continues to expand with the application of these systems to management of large upper-tract urinary stones, with or without concomitant pyeloplasty. The known advantages of the robot-assisted approach, including enhanced optics, dexterity, wristed instrumentation, and ergonomics, can facilitate complex reconstruction of the collecting system, including uteropelvic junction repair. With the favorable outcomes of contemporary robot-assisted pyeloplasty series, robot-assisted applications have been translated to pyelolithotomy with or without concomitant upper-tract reconstruction. The early results of robot-assisted lithotomy reveal the procedure is a safe and efficacious approach for patients with large renal stones; nevertheless, the technique has met limited success in cases of large staghorn calculi. Our purpose was to evaluate the current role of robot-assisted pyelolithotomy for the management of large renal calculi. CONCLUSION Given the known advantages of the robotic system in conjunction with its reconstructive capabilities, the applications of robot-assisted pyelolithotomy, although encouraging, warrant further longitudinal, multi-institutional investigation. This technique is in its early stage of implementation and randomized trials that compare robot-assisted outcomes with other minimally invasive techniques are needed to define clinical efficacy as it pertains to subsets of patients with variable stone size, location, and consistency.
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Affiliation(s)
- Gina M Badalato
- Department of Urology, Columbia University College of Physicians and Surgeons , New York, NY, USA
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Nadu A, Schatloff O, Morag R, Ramon J, Winkler H. Laparoscopic surgery for renal stones: is it indicated in the modern endourology era? Int Braz J Urol 2009; 35:9-17; discussion 17-8. [PMID: 19254393 DOI: 10.1590/s1677-55382009000100003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. MATERIALS AND METHODS Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. RESULTS Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214). Stone free status was 77% (10/13) and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. CONCLUSIONS In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.
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Affiliation(s)
- Andrei Nadu
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Honeck P, Wendt-Nordahl G, Krombach P, Bach T, Häcker A, Alken P, Michel MS. Does open stone surgery still play a role in the treatment of urolithiasis? Data of a primary urolithiasis center. J Endourol 2009; 23:1209-12. [PMID: 19538063 DOI: 10.1089/end.2009.0027] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The introduction and continuous development of percutaneous nephrolithotomy, the achievement of extracorporeal shock-wave lithotripsy, and the advancements in ureterorenoscopy have led to a revolution in the interventional management urolithiasis. The indications for open stone surgery have been narrowed significantly making it a second- or third-line treatment option. We report on patients undergoing open stone surgery for nephrolithiasis in our department during the last 10 years to examine our indications at a primary urolithiasis center and to determine the clinical situations in which open surgery is a reasonable alternative. PATIENTS AND METHODS We reviewed all patients undergoing open stone surgery for upper urinary tract stones from 1997 until 2007 at the Department of Urology, University Hospital Mannheim. A retrospective chart analysis was performed on these patients to identify factors and indications for open stone surgery. Indications for stone surgery, type of surgery performed, stone complexity, anatomical abnormities present, and the residual stone burden were reviewed. RESULTS During a 10-year period 26 open stone operations were performed in our high-volume center. Indications for open stone removal were complex stone mass with complete or partial staghorn stones, concomitant open surgery, nonfunctioning stone-bearing lower poles, the desire to facilitate future stone passages in cystine stone formers, multiple stones in peripheral calyces, and failed minimal invasive procedures. Procedures performed for stone removal included radial nephrotomies, extended pyelolithotomy, lower pole resection, partial nephrectomy, and ileum ureter replacement. Immediate stone-free rate after a single procedure was 69% (18/26 patients). CONCLUSIONS Although today most stone cases can be handled by minimally invasive treatment, open stone surgery maintains a mandatory role in very selected cases. The most common indication in our series though was complex stones with a high stone burden especially in combination with anatomical variations.
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Affiliation(s)
- Patrick Honeck
- Department of Urology, Mannheim University Hospital, Mannheim, Germany.
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Minimal access surgery in the management of pediatric urolithiasis. J Pediatr Urol 2009; 5:42-6. [PMID: 18805739 DOI: 10.1016/j.jpurol.2008.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 07/28/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE In contrast to adult patients, a relatively large number of open surgical procedures are still needed in the treatment of urolithiasis in children. Since almost all open surgical techniques may be reproduced by minimal access surgery (MAS), there is a rationale to apply the latter in the management of pediatric urolithiasis. Our study aimed to assess the feasibility and outcome of MAS in the treatment of pediatric urinary calculi. MATERIALS AND METHODS The charts of patients with urolithiasis submitted to MAS between 1994 and 2007 were retrospectively reviewed. The inclusion criteria were contraindication for and failure of lithotripsy or endourology techniques. Demographic data, lithiasis characterization (location, dimension, composition), predisposing factors (anatomic or metabolic) and surgical approach (technique and outcome) were evaluated. RESULTS Fifteen consecutive patients (eight girls, seven boys) with a median age of 108 months (range: 10-297) were elected for MAS. Eleven (73%) children had associated urogenital malformations and three (20%) presented metabolic abnormalities. A total of 17 procedures were performed laparoscopically: three nephrolithotomies (one transperitoneal, two by retroperitoneoscopy), four pyelolithotomies (retro), three ureterolithotomies (trans) and seven cystolithotomies (suprapubic approach). Five patients underwent concomitant correction of urological anomalies (three calyceal diverticula, one obstructive megaureter, one ureteropelvic junction obstruction). Complete removal of calculi was accomplished in 14 (82%) procedures. There were two perioperative complications (one intraperitoneal vesical perforation and one perivesical urinoma). At a median follow up of 4 years (range: 1 month to 11 years), four patients have developed recurrence. CONCLUSIONS Minimal access surgery is an effective and safe approach for urolithiasis in children who are not candidates for minimally invasive modalities. Individualized application of different techniques may solve virtually all cases. In selected cases, the role of MAS as first-choice therapy deserves consideration.
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Al-Hunayan A, Abdulhalim H, El-Bakry E, Hassabo M, Kehinde EO. Laparoscopic pyelolithotomy: Is the retroperitoneal route a better approach? Int J Urol 2008; 16:181-6. [DOI: 10.1111/j.1442-2042.2008.02210.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lithiase urinaire et laparoscopie. Traitement des calculs du rein (hors anomalies fonctionnelles ou anatomiques). Prog Urol 2008; 18:938-42. [DOI: 10.1016/j.purol.2008.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 11/30/2022]
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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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Symons SJ, Ramachandran A, Kurien A, Baiysha R, Desai MR. Urolithiasis in the horseshoe kidney: a single-centre experience. BJU Int 2008; 102:1676-80. [PMID: 18782315 DOI: 10.1111/j.1464-410x.2008.07987.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To report the operative management and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidney and treated at one centre. PATIENTS AND METHODS We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 15-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. RESULTS In all, 55 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 60 renal units in 47 patients. Five patients had extracorporeal shock wave lithotripsy (ESWL), two had flexible ureteroscopy and one had a laparoscopic pyelolithotomy for a stone extending into the isthmus. PCNL was used for large stones (mean digitized surface area = 614.32 mm(2)) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures, completely cleared in two-thirds of patients treated by ESWL, and in both who had flexible ureteroscopy and the one treated with laparoscopic pyelolithotomy. Complications were minimal, with 15% minor and 3% major complications in the PCNL group only. CONCLUSION Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.
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Affiliation(s)
- Stephanie J Symons
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Laparoscopic Pyeloplasty with Concomitant Pyelolithotomy: Technique and Outcomes. J Endourol 2008; 22:1251-5. [DOI: 10.1089/end.2008.0003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Role of laparoscopic stone surgery. Urology 2008; 71:578-80. [PMID: 18387386 DOI: 10.1016/j.urology.2007.10.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 08/31/2007] [Accepted: 10/25/2007] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To define the role of laparoscopic stone surgery in current urologic practice. METHODS All cases of laparoscopic surgery for renal calculus disease performed at a single institution during a 2-year period were reviewed. A total of 449 stone-removing procedures were performed by one of us (D.G.A.) during this interval, of which 5 were laparoscopic (1.1%). Of the five laparoscopic procedures, three were pyelolithotomy/pyeloplasty, one was laparoscopic-assisted percutaneous nephrostolithotomy, and one was caliceal diverticular stone removal. RESULTS All 5 patients were rendered stone free, and no patient had perioperative complications. CONCLUSIONS A laparoscopic approach is rarely needed in patients requiring stone removal. However, it can be a safe and effective approach in the management of select patients with complex stone disease.
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Simforoosh N, Aminsharifi A, Tabibi A, Noor-Alizadeh A, Zand S, Radfar MH, Javaherforooshzadeh A. Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi. BJU Int 2008; 101:1293-6. [PMID: 18284405 DOI: 10.1111/j.1464-410x.2008.07516.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To evaluate the efficacy of a laparoscopic approach for managing large staghorn renal calculi. PATIENTS AND METHODS Laparoscopic transperitoneal anatrophic nephrolithotomy was used to duplicate open anatrophic nephrolithotomy in five patients (three men) with large staghorn renal stones unsuitable for percutaneous nephrolithotomy. Only the renal artery was clamped, using a bulldog clamp. The stone was removed through a nephrotomy incision on the Brodel line, which was closed using 3/0 polyglactin continuous sutures, and sutures were buttressed by haemostatic clips instead of knots. Intraoperative ultrasonography was used in the last two patients to evaluate residual stones. RESULTS The mean (range) stone size was 53 (45-65) mm, the patient age was 53 (45-58) years, and the warm ischaemia and operative duration were 32 (29-35) and 170 (120-225) min, respectively. No blood transfusion was needed during or after surgery. All of the procedures were uneventful and there was no urine leakage after surgery. Only an 8-mm and a 6-mm residual stone remained in the first and third patients, in the lower and middle calyces, respectively. Both of them were subsequently treated with shock wave lithotripsy. An intravenous pyelogram after surgery showed a functional corresponding renal unit, with a significant improvement in obstruction in all patients. CONCLUSION Laparoscopic anatrophic nephrolithotomy is a promising alternative for patients who are candidates for open surgery, with an acceptable stone-free rate. While offering a minimally invasive approach, it can minimize the need for secondary invasive interventions. Further patients and a longer follow-up are needed before this is suggested as the preferred method in selected patients in the future.
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Affiliation(s)
- Nasser Simforoosh
- Shaheed Labbafinejad Hospital, Urology Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
BACKGROUND AND PURPOSE Laparoscopic pyelolithotomy, although uncommonly performed, may be considered in patients who have renal anomalies, are poorly compliant, and have a large single renal-pelvic calculus. We present our experience with this procedure in five patients. PATIENTS AND METHODS Three patients underwent laparoscopic pyelolithotomy because of a horseshoe kidney, one for a pelvic kidney, and one for a large renal-pelvic calculus. All stones were solitary with a mean size of 2280 mm2 (range 540-8200 mm2). All were approached transperitoneally with passage of a flexible cystoscope through a laparoscopic port to aid in stone extraction. RESULTS All cases were completed laparoscopically. The length of surgery was 74, 92, 134, 158, and 159 minutes. There were no minor or major complications, and the estimated blood loss was <50 mL in all cases. All patients were discharged on postoperative day 1 with the drains removed. Four patients were stented for 4 to 6 weeks. The remaining patient was not stented because of poor compliance. The stents were removed with office cystoscopy. All patients were stone free on follow-up imaging. CONCLUSIONS Laparoscopic pyelolithotomy can be done safely, effectively, and efficiently with proper patient selection and adherence to standard laparoscopic surgical principles.
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Affiliation(s)
- Brandan A Kramer
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9665, USA
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Pure robotic extended pyelolithotomy: cosmetic replica of open surgery. J Robot Surg 2007; 1:207-11. [PMID: 25484964 PMCID: PMC4247432 DOI: 10.1007/s11701-007-0039-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 08/20/2007] [Indexed: 11/21/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) has replaced open pyelolithotomy as the procedure of choice for treating large-burden renal stone disease, especially staghorn calculi. Although it is a minimally invasive procedure, it involves transgressing the renal parenchyma and is thus associated with its unique set of complications. The evolution of laparoscopic pyelolithotomy and robotic assistance has provided an opportunity to the surgeon to revisit pyelolithotomy in a minimally invasive manner following the age-old principles of the era of open renal surgery. We report the feasibility and our experience with this technique in three cases of partial staghorn calculus with intra-renal pelvis.
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