Retroperitoneal laparoscopic pyelolithotomy: how does it compare with percutaneous nephrolithotomy for larger stones?

Abstract

Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.

Evaluation of the role of preoperative Double-J ureteral stenting in retroperitoneal laparoscopic pyelolithotomy

“…Other stent-related complications encountered in the study were dysuria in 18.8% and minor hematuria in 6.2% of cases in group A. [3,6,9,10]. Complication rates in our study were comparable to other published studies.…”

“…In 15.4% of patients with intrarenal pelvis, suturing of pyelotomy could not be performed. In other studies, patients with intrarenal pelvis also have been included as part of the study group, but they have not mentioned the implications of intrarenal pelvis on urinary leakage (Gaur et al (15/43 cases), Chander et al (9/56 cases)) [6,9]. Because closure of pyelotomy has been reported variably in different studies, it can be concluded that the ability to close pyelotomy laparoscopically depends on the operating surgeon's experience with endosuturing.…”

“…It also can be opted as a treatment option for patients in whom PCNL, ESWL, and ureterorenoscopy have failed or where repeated attempts are anticipated [3,5]. This procedure has been compared with PCNL with variable results; however, it has advantage of lesser postoperative pain and shorter convalescent period than open surgery [6,7].…”

Laparoscopic retroperitoneal pyelolithotomy and open pyelolithotomy: a comparative study

“…The age difference between the groups was not statistically significant (p>0.05). Gaur, Pujani et al [7] reported a similar age distribution in their study, with a mean of 39.12 years. Jagdish Chander et al [12] reported a mean age of 33.74 years (18-60 yrs) in the group used in their study.…”

“…Micali Moore et al [4] reported a conversion rate of 11.76% (2/17) in their study. Similarly, Gaur et al 7 (2001) reported a conversion rate of 16.3% (7/43) in their study.…”