Comparison of Surgical Outcomes Between Laparoscopic Pyelolithotomy and Percutaneous Nephrolithotomy in Patients with Multiple Renal Stones in Various Parts of the Pelvocalyceal System

The experience of a tertiary referral center with laparoscopic pyelolithotomy for large renal stones during 18 years

This study aimed to evaluate the outcomes of laparoscopic pyelolithotomy, including its efficacy and feasibility in treatment of large renal stones. All patients who underwent laparoscopic pyelolithotomy operations in a referral center were enrolled from 2003 to 2020. The final analysis included 436 patients. The total stone free rate was 88.3% and the stone-free rate for staghorn/multiple stones versus other types of stones was 81% vs. 91% (P = 0.002). Likewise, the total operation duration was 158 ± 50 and the operation duration for staghorn/multiple stones versus other types of stones was 171 ± 51 min vs. 153 ± 49 min (P < 0.001). The operation duration (169 ± 51 vs. 155 ± 58 vs. 155 ± 42 min) and hospitalization (4.5 ± 2.3 vs. 4.0 ± 2.2 vs. 3.6 ± 1.8) decreased with increasing the surgeons' experience over time. The outcomes of laparoscopic pyelolithotomy for children versus adults versus geriatric patients and in patients with normal versus abnormal kidney anatomy did not reveal statistically significant differences. Laparoscopic pyelolithotomy could be employed as an alternative surgical approach for patients with large kidney stones of any age or with kidney abnormalities provided that appropriate expertise is available to carry out the procedure.

2022 Recommendations of The AFU Lithiasis Committee: Open surgery and laparoscopy

Only few hundred interventions are performed in France each year to remove upper urinary tract stones using a laparoscopic/robotic transperitoneal or retroperitoneal approach. These interventions are proposed to patients with large (>20mm) and complex stones, sometimes after failure of endoscopic techniques or in the presence of malformations that can be treated at the same time. The major interest of these interventions is the possibility to remove the whole stone without prior fragmentation. Some anatomical situations can increase the technical difficulty, particularly the presence of an intrarenal pelvis and the presence of pelvic and periureteral adhesions. The reported complications are essentially urinary fistula and ureteral stenosis, the risks of which are reduced by the use of double J stenting. As struvite stones are more friable, their whole removal is more difficult and may lead to dispersion of fragments, particularly during laparoscopy. Conventional open surgery has a higher stone-free rate, but comes with a greater kidney function loss. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) (EAU Guidelines on urolithiasis. 2022) and their adaptability to the French context.

Meta-Analysis of Laparoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy as a Treatment of Large Kidney Stones

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The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis

INTRODUCTION

The aim of this systematic review and meta-analysis is to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones.

EVIDENCE ACQUISITION

An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded.

EVIDENCE SYNTHESIS

Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP.

CONCLUSIONS

PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.

THE FUNCTIONAL STATE OF THE RENAL PARENCHYMA AFTER VARIOUS VIDEO ENDOSURGICAL METHODS OF TREATMENT OF PATIENTS WITH LARGE AND COMPLEX KIDNEY STONES

The work is based on the analysis of literature data devoted to the problem of preserving the functional state of the kidneys with various video endoscopic methods of surgical treatment of large and complex kidney stones. The purpose of the review is to highlight the likelihood of deterioration in the functional state of the kidneys in the postoperative period. A detailed analysis of postoperative outcomes in various minimally invasive methods of treatment of patients with large and complex kidney stones was carried out, with an overview of the possibility of using dynamic nephroscintigraphy as a method of objectively assessing the functional state of the kidneys.

Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

Background

We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm.

Methods

We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals.

Results

We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL.

Conclusion

LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

Laparoscopic pyelolithotomy in patients with previous ipsilateral renal stone surgery

OBJECTIVES

To evaluate the safety and efficacy of transperitoneal laparoscopic pyelolithotomy in renal stone cases with previous renal surgeries.

PATIENTS AND METHODS

In this prospective study, 190 consecutive patients with renal stones, who were candidates for transperitoneal laparoscopic pyelolithotomy, were enrolled. The patients were divided into two groups. In group A, 163 patients without a history of renal surgery underwent standard laparoscopic pyelolithotomy, whereas in group B laparoscopic pyelolithotomy was performed in 27 patients with a history of kidney stone surgery including percutaneous nephrolithotomy or open stone surgery. All intraoperative data including the operating time and complications such as bleeding requiring transfusion were recorded. Postoperative data such as length of hospitalization, hemoglobin level alteration, and other complications were also recorded.

RESULTS

There was no significant difference in the preoperative data such as stone size, stone site, age, sex, and stone side between the two groups. There was no significant difference in the stone-free rate between the two groups (p = 0.4). There was no significant difference between the two study groups regarding the operating time, hospital stay, stone-free rate, complications, and transfusion rate.

CONCLUSION

Laparoscopic pyelolithotomy can be used as a safe and feasible treatment modality in the setting of previous renal surgery. The complications and stone-free rate of laparoscopic pyelolithotomy in patients with history of renal surgery are acceptable.

Real-Time Ultrasound-Guided Percutaneous Nephrolithotomy Using Newly Developed Wireless Portable Ultrasound: A Single-Center Experience

OBJECTIVES

To assess the feasibility and utility of a newly developed wireless portable ultrasound "UProbe- 2" for puncture guidance in percutaneous nephrolithotomy (PCNL).

MATERIALS AND METHODS

The UProbe-2 consists of a probe with integrated ultrasound circuit boards inside, an intelligent terminal that installed specific ultrasound software, and a puncture trestle. The probe can connect to an intelligent terminal via WI-FI. It was used to guide puncture in PCNL in 31 patients who suffered kidney stones or large impacted proximal upper ureteral stones with hydronephrosis from June 2016 to July 2017. Patients' characteristics as well as parameters during operation were collected.

RESULTS

PCNL was successfully performed in all patients with the guidance of the UProbe-2. The mean (standard deviation) puncture time was 3.6 (0.9) minutes, and the median operative duration was 50 (35-80) minutes. The primary stone clearance rate was 87% (27/31). No major intraoperative or postoperative complications occurred.

CONCLUSION

The UProbe-2 ultrasound is safe and effective for puncture guidance during PCNL according to this initial study. It could provide a new and alternative choice for guidance of PCNL. However, more clinical trials especially randomized controlled trials should be performed.

Management of Pediatric Urolithiasis Using a Combination of Laparoscopic Lithotomy and Pyeloscopy

BACKGROUND

Minimally invasive procedures have become the standard option for treatment of urinary stones; the use of more invasive techniques is not a common practice currently. This emergent technology is not always available and laparoscopy is the alternative option. There are few reports of laparoscopic management for urinary lithiasis in pediatric patients. This study is about the use of laparoscopic surgery combined with pyeloscopy as a feasible first-line treatment for pediatric urolithiasis in renal and proximal ureteral locations.

PATIENTS AND METHODS

We reviewed the records of 14 patients with renal and proximal ureteral stones who underwent laparoscopic pyelolithotomy and pyeloscopy in a period from January 2011 to July 2016. The outcome measures were needed for auxiliary procedures, treatment success, and complication rates.

RESULTS

A total of 16 procedures were carried out in 14 patients, 15 transperitoneal and 1 retroperitoneal laparoscopic pyelolithotomies were done. It was necessary to perform upper ureterolithotomies to remove ureteral stones in 2 cases. The holmium laser and/or pneumatic lithotripter were used to fragment staghorn calculi. Some of the complications were blood transfusion in 12.5% and self-limited urinary leak in 18.7% of the patients. The success rate after undergoing one procedure was 92.8%.

CONCLUSIONS

Transperitoneal or retroperitoneal laparoscopic lithotomy is a safe and feasible procedure for the treatment of pediatric urolithiasis. It can be an alternative to shock-wave lithotripsy and percutaneous nephrolithotomy when these are not feasible or possible.

Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy

Background

Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, laparoscopic pyelolithotomy (LPL) can be used as an alternative management procedure. The aim of present study was to compare LPL and PCNL in terms of efficacy and safety for the management of large renal pelvic stones.

Methods

A literature search was performed in Jan 2016 using electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) to identify relevant studies for the meta-analysis. Only comparative studies investigating LPL versus PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs) with 95% confidence intervals (CIs).

Results

Five randomized and nine non-randomized studies were identified for analysis, involving a total of 901 patients. Compared with PCNL, LPL provided a significantly higher stone-free rate (OR 3.94, 95% CI 2.06–7.55, P < 0.001), lower blood transfusion rate (OR 0.28, 95% CI 0.13–0.61, P = 0.001), lower bleeding rate (OR 0.20, 95% CI 0.06–0.61, P = 0.005), fewer hemoglobin decrease(MD -0.80, 95% CI -0.97 to −0.63, P < 0.001), less postoperative fever (OR 0.38, 95% CI 0.21–0.68; P = 0.001), and lower auxiliary procedure rate (OR 0.24, 95% CI 0.12–0.46, P < 0.001) and re-treatment rate (OR 0.20, 95% CI 0.07–0.55, P = 0.002). However, LPL had a longer operative time and hospital stay. There were no significant differences in conversion to open surgery and prolonged urine leakage rates between LPL and PCNL.

Conclusions

Our present findings suggest that LPL is a safe and effective approach for management of patients with large renal stones. However, PCNL still suitable for most cases and LPL can be used as an alternative management procedure with good selection of cases.

Electronic supplementary material

The online version of this article (10.1186/s12894-017-0266-7) contains supplementary material, which is available to authorized users.

Complex multiple renal calculi: stone distribution, pelvicalyceal anatomy and site of puncture as predictors of PCNL outcome

PURPOSE

Management of patients with complex multiple renal calculi has always remained challenging and they pose many difficulties during percutaneous nephrolithotomy (PCNL) like higher incidence of residual calculus and multiple tracts requirement. The aim of our study was to evaluate the impact of pelvicalyceal system (PCS) anatomy, stone distribution and the site of puncture on the outcome of PCNL in patients with complex multiple renal calculi.

MATERIALS AND METHODS

One hundred and ten patients with complex multiple renal calculi undergoing PCNL during January 2015 to December 2015 were enrolled in our study. Pelvicalyceal anatomy and the stone distribution were determined from intravenous urography. PCNL was done using standard technique. We evaluated the impact of PCS anatomy, stone distribution and the site of puncture on the surgical outcome.

RESULTS

Of all the studied pelvicalyceal anatomy variables, infundibular width, intercalyceal angle and PCS surface area affected the number of punctures. Stone distribution involving all the three calyces or middle and lower calyces was most unfavourable for achieving complete stone clearance. The middle calyceal puncture was almost equally good as the upper calyceal puncture in achieving stone clearance. With timely multiple punctures done, there was neither significant haemoglobin fall nor creatinine rise.

CONCLUSION

Pelvicalyceal anatomy, stone distribution and site of puncture impacts the number of punctures required and stone clearance achieved in patients with complex multiple renal calculi undergoing PCNL. Based on these parameters we can predict which patient has a high likelihood of requirement of multiple punctures. With timely multiple punctures done, there is neither significant haemoglobin fall nor creatinine rise.

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis

To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using the following search terms: renalpelvic stone, percutaneous nephrolithotomy, laparoscopic pyelolithotomy. Randomized controlled and prospective and retrospective two-armed studies were included. Sensitivity analysis and assessment of the quality of the included studies and publication bias were performed. Nine studies were included in the study with a patient population of 622. The studies were homogeneous with respect to the primary end point of stone-free rate, but were heterogeneous with respect to operation time, length of hospital stay, and blood loss. A higher percentage of patients who received LP remained stone-free following surgery compared with patients who were treated with PCNL (p=0.001). However, the mean operation time was longer for patients with LP than for those treated with PCNL (p=0.002). There was no difference between procedures with regard to length of hospital stay or blood loss (p≥0.071). Sensitivity and quality analysis indicated that the data are reliable and the included studies are of good quality. No publication bias was observed. The study suggests that both procedures are effective and safe for removing large renal stones. However, LP may be more efficacious than PCNL in treating large kidney stones.

[Comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy for renal pelvic stones larger than 2.5 cm]

OBJECTIVE

To compare the safety, efficacy and complications of laparoscopic pyelolithotomy (LPL) and percutaneous nephrolithotomy (PCNL) for treatment of renal pelvic stones larger than 2.5 cm.

METHODS

From 2011 to 2016, 32 patients underwent LPL and another 32 patients received PCNL for renal pelvic stones larger than 2.5 cm. The baseline characteristics of the patients, stone size, mean operative time, estimated blood loss, postoperative hospital stay, stone-free rate, postoperative analgesia, blood transfusion, and the intraoperative, early postoperative and long-term complications were compared between the two groups.

RESULTS

The baseline characteristics and stone size were comparable between the two groups. The mean operative time of LPL and PCNL was 117∓23.12 and 118.16∓25.45 min, respectively (P>0.05). The two groups showed significant differences in the mean estimated blood loss (63∓11.25 vs 122∓27.78 mL, P<0.01) and blood transfusion rate (0 vs 6.2%, P<0.01) but not in postoperative hospital stay (4.5∓1.34 vs 4.8∓2.2 days, P>0.05), stone-free rate (93.1% vs 87.5%, P>0.05) or the postoperative analgesia time (1.7∓0.5 and 1.9∓0.6 days, P>0.05). The incidence of intraoperative complications were significant lower in LPL group than in PCNL group (6.2% vs 25.0%, P<0.01), but the incidences of early postoperative complications (25.0% vs 34.4%, P>0.05) and long-term postoperative complications (9.4% vs 12.5%, P>0.05) were similar between them.

CONCLUSION

PCNL is the standard treatment for pelvic stones larger than 2.5 cm, but for urologists experienced with laparoscopic technique, LPL provides a feasible and safe option for management of such cases.