Management of Pelvic Stones Larger than 20 mm: Laparoscopic Transperitoneal Pyelolithotomy or Percutaneous Nephrolithotomy?

Abstract

Large pelvic stones are frequently managed with percutaneous nephrolithotomy (PCNL) but laparoscopic transperitoneal pyelolithotomy (LTP) can be an alternative. We compared PCNL and LTP for the treatment of pelvic stones >20 mm in diameter. Patients and Methods: Between November 1999 and November 2004, 16 consecutive patients, mean age 42, with a single pelvic stone >20 × 10 mm (group I), underwent LTP as first-line treatment or after shockwave lithotripsy failure. They were compared with a similar population of 16 consecutive patients, mean age 45 (group II), who underwent PCNL for the same indication and were assessed retrospectively. We evaluated operative characteristics, complications, and results for each technique. Results: There was no difference between the two groups regarding the characteristics of patients and stones. Operative time duration was significantly longer in group I (129 vs. 75 min; p = 0.001) and conversion was required in 2 patients (12%). The main postoperative complications were urinary leakage (2 patients, 12%) in group I and bleeding (3 patients, 18%) in group II, but only 1 required blood transfusion. Mean hospital stay was respectively 6.5 and 5.6 days in groups I and II (p = 0.17). Stone-free rates were assessed at 3 months and were not different between group I and group II (88 vs. 82%). Conclusions: The operative time of LTP is longer and the results of both techniques are comparable but postoperative morbidity is different. Specific indications of each technique must be determined although PCNL remains the gold standard for most large pelvic stones.

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

“…Meria and colleagues 21 and Goel and colleagues 22 found significantly longer mean operative times for LPL than for PNL (184 vs. 139 minutes, respectively, p = 0.02; and 142 vs. 72 minutes, respectively, p < 0.0001). A third non-randomized controlled trial by Gaur and colleagues 23 reported a mean operative time of 116 minutes for LPL, compared with 152 minutes for PNL (p value not stated).…”

“…The mean operative time of LPL in our study, however, was acceptable and average in relation to many studies. 21,24,25 When compared with PNL, one outstanding advantage of LPL is that it is harmless to the parenchyma. 26 Therefore, the risk of bleeding is higher in PNL related to the access localization and dilation technique.…”

“…Postoperative fever is a common medical complication associated with PNL (23%-25%), 27 and urosepsis develops in only a small fraction of these febrile patients (1%-2%). 28 Meria and colleagues 21 reported an insignificant difference in the stone-free rate between LPL (88%) and PNL (82%). The high stone-free rate achieved in the current study was due to proper selection of cases, the intact removal of the stone in contrast to PNL in which disintegration of the stone by the pneumatic lithotripsy may have left some residuals, and the increased learning curve.…”

“…+ PUJO (1) Malrotated (2) Horseshoe (1) N/A LPL: laparoscopic pyelolithotomy; PNL: percutaneous nephrolithotomy; SD: standard deviation; PUJO: pelvi-ureteric junction obstruction; N/A; not applicable. leagues 21 compared PNL with LPL and found significant venous bleeding in 3 of the 16 patients managed with PNL and the estimated blood loss was more significant in the PNL group (70 vs. 210 mL). Also in our study the mean blood loss was significantly less in the LPL group (65 ± 12.25 vs. 180 ± 20.74 mL), with no need for blood transfusion in all the cases.…”

Laparoscopic Pyelolithotomy in Selected Patients with Ectopic Pelvic Kidney: A Feasible Minimally Invasive Treatment Option

“…All endoscopic techniques, including laparoscopic approaches, have been described to treat patients with stones in ectopic pelvic kidneys. [8][9][10][11] While SWL enjoys the least invasive approach, it is associated with a significantly lower success rate compared with the rate for normal located kidneys. 1,5 Flexible ureteroscopy is another option, but it is also associated with more technical difficulties because of ureteral kink.…”