The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

Abstract

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.

Laparoscopic Pyelolithotomy: Comparison of Surgical Outcomes in Relation to Stone Distribution Within the Kidney

“…Recently, some studies have reported favorable results using LP, with stonefree rates of 88.9%-100% in managing solitary renal pelvic stones. [9][10][11][12] In our study, the stone-free rate in Group I (located only in the pelvis) was 96.7% (29/30), which is comparable to results reported by other centers. LP, therefore, should be considered a feasible modality in the management of renal pelvic stones.…”

“…8 Recently, some previous studies published high success rates using LP for patients with solitary renal stones. [9][10][11][12] However, the effects of stone burden and location on the surgical outcomes of LP have yet to be reported.…”

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

“…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. Bleeding is the most important and frequent complication in PNL.…”

“…They defined this as a new indication for laparoscopy in a developing country. Tefekli and colleagues 26 reported their experience with LPL in 26 patients with solitary pelvic stone in comparison with matched group of PNL; their stone free rate was 100% and 88.4%, respectively.…”

Taş Hastalığında Açık ve Laparoskopik Cerrahinin Yeri Var Mı?

“…Ülkemizde yapılan LP ile PNL'yi karşılaştıran bir çalış-mada, PNL grubunda operasyon süresi ve hastanede kalış süresinin daha kısa, LP grubunda ise kan kaybının daha az olduğu, taşsızlık oranlarının ise benzer olduğu gösterilmiştir (19). LP'nin soliter böbrekte PNL ile karşılaştırılmasında, taşsızlık oranları, kan kaybı, hastanede kalış süreleri ve morbidite açısından benzer olduğu ancak operasyon süresinin LP'de daha uzun olduğu gösterilmiştir (20).…”