Laparoscopic Pyelolithotomy for Partial Staghorn Stones

Abstract

Objective: To confirm the feasibility and safety of laparoscopic pyelolithotomy in partial staghorn stones. Patients and Methods: Seventeen patients who underwent laparoscopic pyelolithotomy for partial staghorn stone were included in the prospective study at King Abdulaziz University Hospital in the period between May 2007 and Feb 2009. Preoperatively all patients had blood work, urine culture, ultrasonography and CT renal stone study. Inclusion criteria included stones with largest diameter of more than 25 mm (measured by CT), branching into one or more group of calices, and no contraindication for laparoscopic surgery. All patients underwent cystoscopy, double J stent insertion prior to the procedure, while prophylactic antibiotics were provided for all the patients with or without positive urine culture. Results: All patients were completed laparoscopically where none required conversion to open surgery or developed intraoperative complications. The largest diameter of the stones varied between 29 and 48 mm with mean diameter of 41 mm, and the number of stones removed was 1–4 with mean of 1.3. The mean operative time was 175 minutes (range 125–240 minutes) and the estimated blood loss was 20–150 ml with mean of 49 ml. All patients cleared from their stones except 2 patients had small residual stones of 5 and 7 mm which were managed later by extracorporeal shock wave lithotripsy. One patient developed ileus postoperatively. Conclusion: Laparoscopic removal of partial staghorn stones is safe and feasible and has an equal outcome to open surgery.