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

Abstract

Background: The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL). Methods: This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm 2 or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed. Results: There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 ± 12.25 [range: 52.75-77.25] vs. 180 ± 20.74 [range: 159.26-200.74] mL, p ≤ 0001), mean hospital stay (2.3 ± 0.64 [range: 1.66-2.94] vs. 3.7 ± 1.4 [range: 2.3-5.1] days, p ≤ 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ≤ 0.0024), and stone-free rate (80% vs. 78.6%, p ≤ 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 ± 22.11 [range: 108.89-153.11) vs. 51.19 ± 24.39 [range: 26.8-75.58] min, p ≤ 0001), respectively. Conclusion: Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones. IntroductionWith the advances in shock wave lithotripsy (SWL) and endourological procedures, such as percutaneous nephrolithotomy (PNL) and ureterorenoscopy (URS), the treatment of urinary stone disease has changed markedly. The indications for open renal surgery to treat renal calculi are limited to special situations; it is needed in only 0.47% to 5.4% of the time.1-4 To treat renal calculi of 2.5 cm 2 or larger in diameter, PNL has been used successfully. With low complication rates, PNL has been accepted as first-line therapy. There are some advantages to laparoscopy despite to its rarity and limited indications. However, advanced experience and high skills are needed for the laparoscopic management of complex stones, such as anatrophric nephrolithotomy. 6,7 With the increase in stone size, success, complications and additional treatment rates differ in patients treated with PNL. 8In centres with established experience in advanced reconstructive laparoscopy, LPL can be a feasible alternative to PNL. 9 In this study, we compared PNL versus LPL in large pelvic stone and investigated the role of LPL. MethodsFrom May 2009 to March 2012, 10 patients with large renal pelvic calculi (2.5 cm 2 or more) were treated with LPL. In the same period, PNL was performed in 42 patients (2 patients had staged bilateral PNL and we therefore excluded from the analysis). An informed written consent was taken from each patient.All patients were documented prospectively in our database. We tallied age, stone location and size. Preoperative complete blood...

Comparison of Safety and Efficacy of Laparoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy in Patients with Large Renal Pelvic Stones: A Meta-Analysis

“…Nine studies met the inclusion criteria and comprised 622 patients 6 9–12 14 15 20 21. The number of patients who received LP and PCNL ranged from 10 to 89 (out of 309 patients in total) and from 12 to 89 (out of 326 patients in total), respectively.…”

Laparoscopic pyelolithotomy in treating extra-renal pelvic calculi at Sanglah General Hospital: a case series

“…Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones. 5 Asim Mushtaq Patloo reported there was no statistically significant difference in the postoperative pain scores or analgesia requirements, and postoperative complication was only slightly more frequently in the laparoscopic group than the open group, but the mean hospital stay of the laparoscopic group was shorter than the open group. 3…”

“…1,2 According to the guidelines, laparoscopic pyelolithotomy (LPL) is indicated when endoscopic procedures fail, if there is a complex stone burden, renal and anatomical abnormalities, or if there are indications for open surgery. [2][3][4][5][6][7][8][9] We reported 7 patients with extrarenal pelvic stone underwent Retroperitoneal Laparoscopic pyelolithotomy. Extrarenal pelvic stone is a stone in the renal calyx and pelvis which is located outside the renal parenchyma.…”

Comparison of ureteroscopy and percutaneous nephrolithotomy for renal pelvic stones over 2 cm

“…The efficacy of PCNL in the treatment of large renal stones was reported in some studies. In one of them, Haggag et al performed PCNL to treat 40 patients with renal pelvic stones larger than 2.5 cm and reported an SFR of 80% [14]. A more recent study including 30 patients with renal pelvic stones over 2 cm reported an SFR of 89%.…”