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Hassan Y, Rather AA, Bashir A, Wani IA, Rasool H. Comparative Study of Laparoscopic and Open Pyelolithotomy in the Management of Large Renal Pelvic Stones. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2022. [DOI: 10.1055/s-0042-1749143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
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.
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Affiliation(s)
- Yaqoob Hassan
- Department of General and Minimal Access Surgery, Sher - i - Kashmir Institute of Medical Sciences Medical College, Srinagar, India
| | - Ajaz Ahmad Rather
- Department of General and Minimal Access Surgery, Sher - i - Kashmir Institute of Medical Sciences Medical College, Srinagar, India
| | - Arshad Bashir
- Department of General and Minimal Access Surgery, Sher - i - Kashmir Institute of Medical Sciences Medical College, Srinagar, India
| | - Ishfaq Ahmad Wani
- Department of General and Minimal Access Surgery, Sher - i - Kashmir Institute of Medical Sciences Medical College, Srinagar, India
| | - Humayoon Rasool
- Department of General and Minimal Access Surgery, Sher - i - Kashmir Institute of Medical Sciences Medical College, Srinagar, India
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Mantica G, Balzarini F, Chierigo F, Keller EX, Talso M, Emiliani E, Pietropaolo A, Papalia R, Scarpa RM, Terrone C, Esperto F. The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis. Minerva Urol Nephrol 2022; 74:169-177. [PMID: 35147384 DOI: 10.23736/s2724-6051.21.04587-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.,European Society of Residents in Urology (ESRU)
| | - Federica Balzarini
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy -
| | - Francesco Chierigo
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Young Academic Urologists (YAU) Urolithiasis & Endourology working party
| | - Michele Talso
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Esteban Emiliani
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, Endourology and Urolithiasis Unit, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, University Hospital Southampton, Tremona Road, Southampton, UK
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU).,Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Mao T, Wei N, Yu J, Lu Y. Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis. J Int Med Res 2021; 49:300060520983136. [PMID: 33472474 PMCID: PMC7829524 DOI: 10.1177/0300060520983136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
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.
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Affiliation(s)
- Tie Mao
- First Operating Room, The First Hospital of Jilin University, Changchun, China
| | - Na Wei
- First Operating Room, The First Hospital of Jilin University, Changchun, China
| | - Jing Yu
- First Operating Room, The First Hospital of Jilin University, Changchun, China
| | - Yinghui Lu
- Third Operating Room, The First Hospital of Jilin University, Changchun, China
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Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years). Int Urol Nephrol 2019; 51:1955-1960. [DOI: 10.1007/s11255-019-02252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023]
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Pyelolithotomy in a Patient with Complete Coraliform Calcification Induced by a Double-J Ureteral Stent. Case Rep Urol 2019; 2019:6957141. [PMID: 31275690 PMCID: PMC6558601 DOI: 10.1155/2019/6957141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022] Open
Abstract
The placement of a double-J ureteral stent enables the treatment of upper urinary tract obstruction. Despite advances, forgetting the stent favors the occurrence of calcification, leading to increased morbidity rates, lawsuits, and a financial burden on the healthcare system. This paper describes a successful pyelolithotomy for the removal of a calcified double-J ureteral stent.
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