Comparison of laparoscopic pyelolithotomy and retrograde intrarenal surgery in the management of large renal pelvic stone

Abstract

Background To compare the clinical outcomes of laparoscopic pyelolithotomy (LP) and retrograde intrarenal surgery (RIRS) in the management of large renal pelvic stones. Methods This study included patients who presented with a single renal pelvic stone sized ≥20 mm and who were treated primarily by laparoscopic pyelolithotomy or retrograde intrarenal surgery. The patients were grouped based on the surgical procedure they underwent. We retrospectively examined and compared the age, the longest axis and the surface area of the stone, operation time, hospitalization time, complications and stone-free rates of the two groups. Results Of the 156 patients included in the study, 44 had laparoscopic pyelolithotomy, and 112 had retrograde intrarenal surgery. Patients who received laparoscopic pyelolithotomy (13 males, 31 females) had a median age of 54 (18-79) years, while those who underwent retrograde intrarenal surgery (46 males, 66 females) had a median age of 54.5 (18-79). Patients who received laparoscopic pyelolithotomy were found to have larger median stone size (30 mm vs 24 mm, p=0.003), longer operation time (100 minutes vs 70 minutes, p=0.007), lower complication rate (2% vs 8.9%, p=0.063), longer median hospital stay (3 days vs 1 day, p<0.001) and better stone-free rate at the third month (90.9% vs 67.9%, p<0.001). Conclusion LP is a safe and efficient procedure that could be used as an alternative to retrograde intrarenal surgery in managing large renal pelvic stones.