Treatment Outcomes After Endopyelotomy Performed with or without Simultaneous Nephrolithotomy: 10-Year Experience

Berkman, Douglas S.; Landman, Jaime; Gupta, Mantu

doi:10.1089/end.2009.0379

Cited by 11 publications

(12 citation statements)

References 13 publications

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“…Until recently, the minimally invasive treatment of choice was percutaneous endopyelotomy in the setting of UPJO and concurrent lithiasis 1,2. Several series have estimated that the success rate of this approach fluctuates from 65%–90% in a maximum follow-up of 55 months 20–22.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature

Stravodimos

Giannakopoulos

Tyritzis

et al. 2014

RRU

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IntroductionApproximately one out of five patients with ureteropelvic junction obstruction (UPJO) present lithiasis in the same setting. We present our outcomes of simultaneous laparoscopic management of UPJO and pelvic or calyceal lithiasis and review the current literature.MethodsThirteen patients, with a mean age of 42.8±13.3 years were diagnosed with UPJO and pelvic or calyceal lithiasis. All patients were subjected to laparoscopic dismembered Hynes–Anderson pyeloplasty along with removal of single or multiple stones, using a combination of laparoscopic graspers, irrigation, and flexible nephroscopy with nitinol baskets.ResultsThe mean operative time was 218.8±66 minutes. In two cases, transposition of the ureter due to crossing vessels was performed. The mean diameter of the largest stone was 0.87±0.25 cm and the mean number of stones retrieved was 8.2 (1–32). Eleven out of 13 patients (84.6%) were rendered stone-free. Complications included prolonged urine output from the drain in one case (Clavien grade I) and urinoma formation requiring drainage in another case (Clavien grade IIIa). The mean postoperative follow-up was 30.2 (7–51) months. No patient has experienced stone or UPJO recurrence.ConclusionLaparoscopy for the management of UPJO along with renal stone removal seems a very appealing treatment, with all the advantages of minimally invasive surgery. Concomitant renal stones do not affect the outcome of laparoscopic pyeloplasty, at least in the midterm. According to our results and the latest literature data, we advocate laparoscopic management as the treatment of choice for these cases.

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Section: Discussionmentioning

confidence: 99%

“…Ureteropelvic junction obstruction (UPJO) and lithiasis of the renal pelvis or the renal calyces can coexist 1. This coexistence might trouble the surgeon urologist, since the selection of the appropriate management can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature

Stravodimos

Giannakopoulos

Tyritzis

et al. 2014

RRU

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“…Laparoscopic pyeloplasty (LP) with concomitant pyelolithotomy [1], [6], [7], [8], [9], [10], [11], percutaneous nephrolithotomy (PNL) with endopyelotomy [3], [12], [13], [14], [15] or robotic assisted laparoscopic pyeloplasty (RALP) with concomitant pyelolithotomy [4] and PNL with LP [2] have been reported for treating UPJO concomitant with renal stones. Each of these methods has its own limitations.…”

Section: Discussionmentioning

confidence: 99%

“…At 6 months patients are stone free on ultrasound and show good drainage on renal scan. Berkman and colleagues [13] retrospectively reviewed patient data for all endoscopic pyeloplasties performed at a single institution over 10 years. Forty-one patients underwent simultaneous nephrolithotomy for ipsilateral renal calculi.…”

Section: Discussionmentioning

confidence: 99%

“…Although the surgical treatment of UPJ obstruction associated with renal calculi has evolved significantly over the past 2 decades [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], there is still therapeutic controversy regarding the ideal minimally invasive management. In the present study, we report a minimally invasive and reproducible technique that greatly facilitates the surgical treatment of this morbidity, using a 7.5F rigid ureteroscopy during mini-laparoscopic pyeloplasty for caliceal stone removal.…”

Section: Introductionmentioning

confidence: 99%

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Transperitoneal Mini-Laparoscopic Pyeloplasty and Concomitant Ureteroscopy-Assisted Pyelolithotomy for Ureteropelvic Junction Obstruction Complicated by Renal Caliceal Stones

et al. 2013

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ObjectiveTo present our experience of combining transperitoneal mini-laparoscopic pyeloplasty (mini-LP) and concomitant ureteroscopy-assisted pyelolithotomy (U-P) for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session.MethodsBetween May 2007 and December 2011, mini-LP and concomitant U-P was performed in nine patients with UPJO and ipsilateral renal caliceal stones. Stone location and burden were preoperatively assessed. After pyelotomy with appropriate length (about 4 mm), a 16-Fr catheter sheath replaced the uppermost or lowermost laparoscopic trocar and was introduced directly into the renal pelvis under the guidance of a guide wire and laparoscopic vision. A 7.5F rigid ureteroscopy passed through the catheter sheath into the plevis. Intracorporeal lithotripsy and/or pressure irrigation via a pump was used for caliceal stone removal. Subsequently, laparoscopic pyeloplasty was performed in a standard fashion. Postoperative imaging was assessed.ResultsThe calculi sizes ranged from 2 to 11 mm (mean, 7.1 mm) and an average of 3 stones per patient was removed (range, 1 to 6 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 210 minutes, and estimated blood loss was 20 mL. Mean hospital stay was 5 days (4–7). Stent was removed after 4–8 weeks. No intraoperative or postoperative complications were noted during a mean follow-up of 18.5 months (range, 6 to 24 months).ConclusionsMini-LP and concomitant U-P are simple and effective alternatives for the simultaneous management of UPJO complicated by coexisting ipsilateral renal caliceal stones.

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Endoscopic Incisions

Violette¹,

Razvi²

2014

Minimally Invasive Urology

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Treatment Outcomes After Endopyelotomy Performed with or without Simultaneous Nephrolithotomy: 10-Year Experience

Abstract: This study demonstrates that UPJO resolves at an equal rate after EP performed with or without ipsilateral renal calculi. Patients with UPJO and renal calculi should undergo stone extraction and EP in the same setting with the expectation of excellent results.

Cited by 11 publications

References 13 publications

Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature

Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature

Transperitoneal Mini-Laparoscopic Pyeloplasty and Concomitant Ureteroscopy-Assisted Pyelolithotomy for Ureteropelvic Junction Obstruction Complicated by Renal Caliceal Stones

Endoscopic Incisions

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