In our experience, laparoscopic extraperitoneal adenomectomy (Millin's procedure) is feasible with minimal invasion and is a simple straightforward technique.

Objectives: Treatment of staghorn calculus is challenging. We evaluated the feasibility and efficacy of the retroperitoneal laparoscopic approach for the management of large staghorn renal calculi. Methods: Patients with staghorn renal calculi unsuitable for percutaneous nephrolithotomy were analyzed. They underwent retroperitoneal laparoscopic anatrophic nephrolithotomy, involving control of the renal artery, stone removal through a nephrotomy incision on the Brodel's line and closure with continuous sutures. Results: A total of 11 patients with renal stones were included in the present study. Mean patient age was 55 years (range 42-68) and stone size was 52 mm (range 43-61). Warm ischemia time and operative duration were 31 (range 23-38) and 139 min (range 105-160), respectively. No blood transfusion was needed during or after operation. An 8-mm residual calculus remained in the lower calyces in one patient who was successfully treated by using shock wave lithotripsy. Intravenous pyelogram after surgery showed a functional corresponding renal unit, with an improvement in obstruction in all patients. Conclusions: Retroperitoneal laparoscopic technique can be applied for patients who are candidates for anatrophic nephrolithotomy. Larger studies with a longer follow up are needed to confirm these findings.

Compared with B-TURP, LSP with Madigan technique is accompanied by less residual adenoma, shorter catheterization time, and more blood loss. Further, the risk of late complications is lower with LSP and, in terms of functional outcomes, LSP appears to be better than B-TURP beyond 2 years.