Simultaneous Treatment of Renal Cysts and Stones with Single-Session Retroperitoneoscopic Renal Cyst Decortication and Retroperitoneoscopy-Assisted Percutaneous Nephrolithotomy

Abstract

Introduction: To determine the safety and efficacy of single-session retroperitoneoscopic renal cyst decortication in conjunction with retroperitoneoscopy-assisted percutaneous nephrolithotomy (PCNL) for simultaneous treatment of renal cysts and stones. Patients and Methods: We enrolled 15 patients (10 men and 5 women, mean age 41 years), who underwent one-stage retroperitoneoscopic renal cyst decortication and retroperitoneoscopy-assisted PCNL between January 2008 and May 2009 for symptomatic renal cysts and concomitant large kidney stones (mean stone area 6.6 cm²). Intraoperative blood loss, duration of operation, and postoperative complications were evaluated. Median follow-up time was 22 months (range 12–26). Results: Average total operative time was 83 ± 12 min and mean duration of PCNL was 45 ± 5 min. Mean estimated blood loss was 80 ± 21 ml. A plain abdominal radiograph revealed an absence of residual stones in all cases. No cyst recurrence occurred within the follow-up period. The mean pre- and postoperative pain score was 7.3 ± 0.8 and 2.8 ± 0.6, respectively. All patients resumed ambulatory activities on the first postoperative day. No severe complications related to the procedure were encountered. Conclusion: The combined laparoscopic approach for simultaneous treatment of renal cysts and stones is safe and feasible. These results encourage further studies to determine long-term outcomes of this combined surgery.

Long-term outcome after flexible ureteroscopy with holmium laser for simultaneous treatment of a single renal cyst and ipsilateral renal stones

“…For instance, a case report by Micali et al 6 described the feasibility of simultaneous laparoscopic treatment of renal stones accompanied by renal cysts. Additionally, Qiu et al 12 performed simultaneous laparoscopic cyst decortication and laparoscopy-assisted PCNL in the treatment of 15 patients with renal cysts and ipsilateral stones, achieving satisfactory stone clearance and no recurrence of cysts during a median follow-up period of 22 months. Laparoscopy offers the advantage of a high initial SFR because stones are removed without residual fragments.…”

“…10 Moreover, it is extremely challenging for surgeons to manage multiple renal stones without the assistance of percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy (FURS). 11,12 Several reports have suggested that percutaneous ureteroscopy with laser unroofing or a plasma column electrode is less invasive than laparoscopy for treatment of simple renal cysts. [13][14][15][16] However, this approach has not been widely applied because of the possibility of serious postoperative complications, such as urinary leakage or massive hemorrhage requiring angio-embolization; 17,18 renal cysts and ipsilateral stones occasionally cannot be managed simultaneously through a single tract because their locations are suboptimal.…”