Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

Abstract

PurposeTo report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy.Materials and MethodsA retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed.ResultsThe patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed.ConclusionsLaparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

Risk factors for urinary infection after retrograde upper urinary lithotripsy

“…[13] Compared with traditional open surgery, intracavitary lithotripsy for upper urinary tract stones has the advantages of less trauma, faster recovery and fewer complications. [14][15][16] However, urinary infections and a delay in the diagnosis and treatment of ureteral obstruction represents the most important prognostic factor for worse results in terms of renal function recovery. [17] urinary tract infection is the main postoperative complication, and severe cases can cause systemic inflammation.…”

“…With the development of minimally invasive techniques, intracavitary lithotripsy for upper urinary tract stones has now become a first-line surgical method for upper urinary tract stones [13] . Compared with traditional open surgery, intracavitary lithotripsy for upper urinary tract stones has the advantages of less trauma, faster recovery and fewer complications [14–16] . However, urinary infections and a delay in the diagnosis and treatment of ureteral obstruction represents the most important prognostic factor for worse results in terms of renal function recovery [17] .…”

Incidência e reincidência da urolitíase em um hospital quaternário: retrospectivo de 15 anos

“…Em relação ao tipo da primeira cirurgia realizada, no presente estudo predominaram ureterolitotripsia (61,4%), ureterolitotomia (11,2%) e nefrolitotomia (8,0%). Jung et al 25 demonstraram que pacientes com cálculos urinários foram submetidos principalmente à litotripsia extracorpórea por ondas de choque (LECO), litotomia ureterorenoscópica ou nefrolitotomia percutânea. Tais dados coincidem com os apresentados pelo presente estudo, e corroboram a hipótese de que as cirurgias endourológicas ganharam espaço, substituindo principalmente cirurgias abertas, tendo em vista que o manejo dos cálculos urinários sofreu alterações nos últimos 30 anos.…”

“…Tais dados coincidem com os apresentados pelo presente estudo, e corroboram a hipótese de que as cirurgias endourológicas ganharam espaço, substituindo principalmente cirurgias abertas, tendo em vista que o manejo dos cálculos urinários sofreu alterações nos últimos 30 anos. 25 Quanto à localização do primeiro cálculo, concluiuse que a maior parte dele localizava-se no ureter (28,3% do lado esquerdo e 25,9% do lado direito) e uma menor parte nos rins (4,8% no rim esquerdo e 4,4% no rim direito). Além disso, 1,6% alojavam-se na bexiga urinária.…”

Laparoscopic nephron-sparing surgery for the treatment of canine dioctophymosis

“…Other indications for nephrotomy, such as the removal of uroliths, exploration of the renal pelvis in cases of neoplasia, or idiopathic hematuria [ 13 , 20 ], can also be performed using laparoscopy. This approach provides a greater level of evidence of anatomical structures, minimal damage to the renal parenchyma, as well as improved stability of blood loss and less pain at the surgical site [ 36 ].…”