Laparoscopic pyelolithotomy: Is the retroperitoneal route a better approach?

Is laparoscopic pyelolithotomy an alternative to percutaneous nephrolithotomy for treatment of kidney stones larger than 2.5 cm in pediatric patients?

PURPOSE

The aim was to compare laparoscopic pyelolithotomy and percutaneous nephrolithotomy in terms of efficacy and safety for the treatment of renal pelvis stones larger than 2.5 cm in pediatric patients.

METHODS

Our study consisted of two groups. Group 1 included 33 patients who underwent laparoscopic pyelolithotomy (LPL) between January 2013 and March 2022, and group 2 included 39 patients who underwent percutaneous nephrolithotomy (PCNL). The basic clinical parameters of the patients were recorded. Mean operation time, stone size, estimated blood loss, blood transfusion rate, postoperative hospital stay, stone-free rate, postoperative analgesia requirements, intraoperative complications, and early and late postoperative complications were compared between the two groups.

RESULTS

In our study, the mean age of the patients in groups 1 and 2 was 8.89 ± 1.58 years and 9.1 ± 1.85 years, respectively (p = 0.657). The mean stone size was 2.37 ± 0.38 cm in group 1 and 2.55 ± 0.45 cm in group 2 (p = 0.64). The mean operation time was 85.65 ± 20.55 min in group 1, while it was 76.11 ± 13.12 min in group 2 (p = 0.08). The stone-free rate was 100% in both groups. Intraoperative mean blood loss, need for postoperative analgesia, blood transfusion and intraoperative complication rates were significantly higher in the PCNL group (p < 0.01, p = 0.02, p < 0.01, p < 0.01, respectively).

CONCLUSION

Our results show that laparoscopic pyelolithotomy is a safe and effective method for pediatric patients with large kidney stones.

Surgery for Xanthogranulomatous Pyelonephritis: A Comparison of Midline Transperitoneal and Flank Retroperitoneal Laparotomy Approaches to Nephrectomy

Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory disease often associated with high morbidity and mortality. Whether the midline transperitoneal or the flank retroperitoneal approach is superior remains unknown. We searched through pathology databases and reviewed 86 patients with an XGP diagnosis from 2000 to 2021 at our institution. After the patients who did not meet the inclusion criteria were excluded, 35 patients who had undergone nephrectomy through the midline transperitoneal or the flank retroperitoneal laparotomy approach were recruited. Nine (25.71%) of the thirty-five patients underwent nephrectomy through a midline approach, whereas twenty-six (74.29%) received a flank approach. Patients in the midline approach group had a longer surgical time (p = 0.03) than those in the flank approach group. In addition, patients in the flank approach group took less time after surgery to resume oral intake than those in the midline approach group (p = 0.01). No significant differences in the rates of intraoperative and postoperative complications such as peritonitis or intraabdominal infection were observed between the groups. For the patients with XGP who are good candidates for surgery, nephrectomy is a relatively safe surgical treatment method. Both surgical methods produced favorable surgical outcomes, and the patients who received these methods had similar complication rates.

Comparative Study of Laparoscopic and Open Pyelolithotomy in the Management of Large Renal Pelvic Stones

Background Large renal pelvic stones can be effectively managed with laparoscopic pyelolithotomy. The aim of this study was to compare the surgical outcomes of laparoscopic pyelolithotomy versus open surgery for the treatment of large renal pelvic stones.

Materials and Methods This prospective comparative study was performed at the Sher-i-Kashmir Institute of Medical Sciences Medical College and Hospital over a period of 8 years. Using computer-generated random numbers, the patients were randomized into two groups: group A received laparoscopic pyelolithotomy, while group B had open pyelolithotomy. The data was collected and analyzed using SPSS software 22.

Results Among 74 patients who met the inclusion criteria, the mean age was 39.18 years with 66.21% being males and a male:female ratio of 1.96. Forty-one (55.41%) patients had open surgery and 33 (44.59%) had laparoscopic pyelolithotomy. The difference in mean operative time of laparoscopy (117.66 minutes) and open (78.13 minutes) surgery was statistically significant (p = 0.05). The mean blood loss was significantly lower in the laparoscopic pyelolithotomy group (62.12 mL) than in the open group (92.07 mL) (p = 0.009). The difference in mean hospital stay between the open and laparoscopic groups was significant (p = 0.02). In both laparoscopy and open surgery, we observed a 100% stone-free rate at the end of 1 month. None of our patients expired during the study period.

Conclusion Laparoscopic pyelolithotomy is a promising alternative to traditional open and other endourological techniques, with encouraging results. Despite its technical difficulty, it yields high stone-free rates and low postoperative morbidity.

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

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Laparoscopic Surgery in Pediatric Upper Tract Urolithiasis: An Alternate Modality

Introduction

Incidence of pediatric urolithiasis has increased over the last few decades. Procedures such as extracorporeal short wave lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopic lithotripsy are not widely available for pediatric age group in many developing countries. It is desirable that advantages of minimally invasive surgery be offered to selected cases with urolithiasis.

Materials and Methods

All patients with pediatric upper tract urolithiasis managed laparoscopically from January 2015 to April 2020 were retrospectively reviewed.

Results

A total of 38 patients were included. The mean age of the patients was 8 ± 2.85 years. Thirty-four patients (renal and upper ureteric) were managed through retroperitoneal approach, while those with lower ureteric calculi (n = 4) were approached transperitoneally. A total of eight patients required conversion to open technique. The stone clearance rate was 79% by laparoscopic approach alone. There were no procedure-related complications.

Conclusion

Our study suggests that laparoscopic management for pediatric upper tract urolithiasis is a radiation-free, single-time curative treatment and is feasible in centers where facilities for other endoscopic procedures are unavailable.

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.

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

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.

The Urological Association of Asia clinical guideline for urinary stone disease

The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline - consisting 43 clinical questions - and overview its key practical issues.

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.

Laparoscopic pyelolithotomy as a monotherapy for the management of intermediate-sized renal pelvic stones

Introduction:

Renal calculi are one of the major reason leading to kidney failure or urinal obstructions. Percutaneous nephrolithotomy is considered as the major management option for intermediate to large renal pelvic stones. In the present study we compare Percutaneous nephrolithotomy vs laparoscopic pyelolithotomy procedures in the management of intermediate sized renal pelvic stones.

Methods:

The time duration of study was between July 2012 and Jan 2014, 20 patients with solitary intermediate sized renal pelvic stones were selected and randomly divided into two groups; group one included 10 patients who were treated by laparoscopic pyelolithotomy and group two included 10 patients who were treated by PCNL. The differences in procedure time, blood loss, stone clearance and duration of hospital stay between the two procedures were compared and analyzed.

Results:

There was no difference between the two groups regarding patient demographics and stone size. There was statistically significant difference between laparoscopic pyelolithotomy and PCNL regarding mean estimated blood loss (<50 mL vs. 180–250 mL), hospital stay (3–5 days vs. 4–6 days), mean time of postoperative analgesia (2.2 ± 0.9 days vs. 2 ± 0.9 days), and stone-free rate (100% vs. 95%). The operative time was significantly longer in the laparoscopic pyelolithotomy group (80–150 min vs. 45–75 min).

Conclusion:

Although PCNL is the gold standard for intermediate-sized renal pelvic stones of 2-4 cm, laparoscopic pyelolithotomy is a suitable surgical technique in selected cases.

Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series

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.

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

OBJECTIVE

This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter.

MATERIAL AND METHODS

A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.

RESULTS

There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery.

CONCLUSION

Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.

Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients

Objectives

To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3–4 cm) in patients with chronic liver disease or coronary artery disease.

Patients and methods

In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated.

Results

The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.

Conclusion

LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.

Randomized controlled trial comparing retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for the treatment of large renal pelvic calculi: a pilot study

PURPOSE

To evaluate the efficacy and safety of retroperitoneal laparoscopic pyelolithotomy (RLP) versus percutaneous nephrolithotomy (PCNL) for large renal pelvic calculi using a randomized controlled trial.

MATERIALS AND METHODS

Patients with large renal pelvic calculi were prospectively randomized using matched-pair analysis (1:1 scenario) into either the RLP group or the PCNL group. The patients in each group underwent the procedure accordingly. Treatment efficacy, safety, and complications were evaluated after surgery.

RESULTS

Finally, 178 eligible patients were included and the demographics and mean stone size of two groups were similar. We found no significant differences in the mean postoperative hospital stay (4.5±2.3 vs. 4.3±1.3 days), rate of blood transfusion (0% vs. 1.1%), conversion rate (0% vs. 3.4%), and rate of total postoperative complication (p>0.05). The procedural duration and mean drop in hemoglobin levels were significantly lower in the RLP group as compared with the PCNL group (90.87±33.4 vs. 116.8±44.4 minutes, p<0.001; 0.9±0.5 vs. 1.7±1.3 g/dL, p<0.001, respectively). Significant differences were also observed in the stone-free rate (98% vs. 90%, p=0.03) and postoperative fever rate (3.4% vs. 13.5%, p=0.02).

CONCLUSIONS

Current evidence suggests that PCNL and RLP are both effective and safe for the treatment of large renal pelvic calculi. Our study shows that, compared with the PCNL approach, RLP for large renal pelvic stone resulted in shorter operative time, less bleeding, less postoperative fever, and a higher stone-free rate. Data from larger, multicenter randomized controlled trials of high quality are needed to further confirm our findings.

Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones

BACKGROUND

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL).

METHODS

This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm(2) or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed.

RESULTS

There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 ± 12.25 [range: 52.75-77.25] vs. 180 ± 20.74 [range: 159.26-200.74] mL, p ≤ 0001), mean hospital stay (2.3 ± 0.64 [range: 1.66-2.94] vs. 3.7 ± 1.4 [range: 2.3-5.1] days, p ≤ 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ≤ 0.0024), and stone-free rate (80% vs. 78.6%, p ≤ 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 ± 22.11 [range: 108.89-153.11) vs. 51.19 ± 24.39 [range: 26.8-75.58] min, p ≤ 0001), respectively.

CONCLUSION

Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones.

Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis

PURPOSE

We assessed the effectiveness and safety of laparoscopic pyelolithotomy and percutaneous nephrolithotomy as surgical management for solitary renal pelvic calculi larger than 2 cm.

MATERIALS AND METHODS

We searched PubMed®, EMBASE®, The Cochrane Library and the Web of Knowledge(SM) databases up to November 9, 2012 for relevant published studies. After data extraction and quality assessment, meta-analysis was performed using RevMan 5.1.

RESULTS

We identified 7 trials in a total of 176 and 187 patients treated with laparoscopic pyelolithotomy and percutaneous nephrolithotomy, respectively. Operative time and hospital stay were 50.62 minutes and 0.66 days shorter in the nephrolithotomy group (p <0.0001 and 0.04, respectively). Patients in the laparoscopic group benefited from a lesser decrease in hemoglobin (OR -1.00, 95% CI -1.77--0.23), less postoperative fever (OR 0.24, 95% CI 0.08-0.72), a lower incidence of bleeding (OR 0.29, 95% CI 0.10-0.85) and a higher stone-free rate (OR 4.85, 95% CI 1.59-14.82). Sensitivity analysis indicated that all results were stable except the stone-free rate showed no statistically significant difference between the 2 groups (OR 0.33, 95% CI 0.09-1.17). No publication bias was detected.

CONCLUSIONS

Current evidence suggests that laparoscopic pyelolithotomy and percutaneous nephrolithotomy are effective and safe for large renal pelvic calculi but laparoscopic pyelolithotomy seems to be more advantageous. However, given the inherent limitations of the included studies, results must be further confirmed in high quality randomized, controlled trials.

Laparoscopic pyelolithotomy: comparison of surgical outcomes in relation to stone distribution within the kidney

Abstract Purpose: To evaluate surgical outcomes of laparoscopic pyelolithotomy (LP) in relation to stone distribution within the kidney.

METHODS

Between August 2008 and February 2012, 77 patients underwent LP as first-line treatment for renal stone(s). Cases were classified into four groups, depending on stone location: Group I (located in only renal pelvis), Group II (located only in renal calyx), Group III (located in renal pelvis and in one calyx), and Group IV (located in renal pelvis and in multiple calyces). Patient and stone characteristics, surgical outcomes, and complications were evaluated.

RESULTS

Sixty-seven (81.8%) cases were stone-free after LP for large renal stones. Stone-free rates in a single session significantly decreased with greater stone dispersion (p<0.001). Mean hospital stay in group IV was significantly longer than in other groups (p=0.038). However, there were no significant differences in mean operation times (p=0.214), mean change in serum hemoglobin (p=0.709), postoperative analgesics usages (p=0.153), and number of analgesics used on an as-needed basis (p=0.079). There were no complications of grade IIIb or of greater severity. One patient in group II received blood transfusion, and 1 in group III required percutaneous drainage due to perirenal urine collection.

CONCLUSIONS

LP is an effective and safe modality for managing renal stones diseases. Distribution of stone burden, and total stone burden, is an important predictor of surgical outcome of LP in renal stone diseases.

Laparoscopic management of a large staghorn stone

Urinary calculi are prevalent and result in significant morbidity, with a marked economic impact. Various therapeutic options exist, from medical to surgical management according to stone size. Laparoscopic pyelolithotomy is a viable option for significant staghorn renal stones. We report the case of a laparoscopic pyelolithotomy performed on a 48-year-old man with a left recurrent staghorn renal stone secondary to an ureteropelvic junction obstruction following a grade IV renal trauma several years ago.

The role of laparoscopic surgery for renal calculi management

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.

Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy

BACKGROUND AND PURPOSE

Percutaneous nephrolithotomy (PCNL) is considered the main management option for large single renal pelvic stones; however, laparoscopic retroperitoneal pyelolithotomy (LRP) can be used as an alternative management procedure. We compare both procedures in the management of solitary large renal pelvic stones.

PATIENTS AND METHODS

Between June 2002 and July 2010, 105 patients with solitary large renal pelvic stones were selected and randomly divided into two groups; group 1 included 55 patients who were treated by LRP and group 2 included 50 patients who were treated by PCNL. The differences between the two procedures were compared and analyzed.

RESULTS

There was no difference between the two groups regarding patient demographics and stone size. There was no statistically significant difference between LRP and PCNL regarding mean estimated blood loss (166.4±98.3  mL vs 178±102.4  mL), mean hospital stay (4.5±1.9 d, vs 4.4±1.4 d), mean time of postoperative analgesia (2.2±0.9 d vs 2.4±0.9 d), rate of postoperative blood transfusion (5.5% vs 6%), and stone-free rate (100% vs 96%). The mean operative time was significantly longer in the LRP group (130.6±38.7  min vs 108.5±18.7  min), respectively. There was only one (1.8%) case from the laparoscopy group converted to open surgery because of uncontrolled bleeding.

CONCLUSION

RLP is a suitable surgical technique for patients with large renal pelvic stones but with good selection of cases; however, PCNL remains the standard treatment in most cases.