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. IntroductionWith the advances in shock wave lithotripsy (SWL) and endourological procedures, such as percutaneous nephrolithotomy (PNL) and ureterorenoscopy (URS), the treatment of urinary stone disease has changed markedly. The indications for open renal surgery to treat renal calculi are limited to special situations; it is needed in only 0.47% to 5.4% of the time.1-4 To treat renal calculi of 2.5 cm 2 or larger in diameter, PNL has been used successfully. With low complication rates, PNL has been accepted as first-line therapy. There are some advantages to laparoscopy despite to its rarity and limited indications. However, advanced experience and high skills are needed for the laparoscopic management of complex stones, such as anatrophric nephrolithotomy. 6,7 With the increase in stone size, success, complications and additional treatment rates differ in patients treated with PNL. 8In centres with established experience in advanced reconstructive laparoscopy, LPL can be a feasible alternative to PNL. 9 In this study, we compared PNL versus LPL in large pelvic stone and investigated the role of LPL. MethodsFrom May 2009 to March 2012, 10 patients with large renal pelvic calculi (2.5 cm 2 or more) were treated with LPL. In the same period, PNL was performed in 42 patients (2 patients had staged bilateral PNL and we therefore excluded from the analysis). An informed written consent was taken from each patient.All patients were documented prospectively in our database. We tallied age, stone location and size. Preoperative complete blood...

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