The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis

Mantica, Guglielmo; Balzarini, Federica; Chierigo, Francesco; Keller, Etienne Xavier; Talso, Michele; Emiliani, Esteban; Pietropaolo, Amelia; Papalia, Rocco; Scarpa, Roberto; Terrone, Carlo; Esperto, Francesco

doi:10.23736/s2724-6051.21.04587-0

Cited by 16 publications

(8 citation statements)

References 36 publications

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“…The treatment of UPJO complicated with kidney stones with a laparoscopic method alone is frequently not desirable. When percutaneous lithotripsy has been performed to treat both UPJO and kidney stones, the postoperative follow-up indicated poor outcomes (4)(5)(6). A two-stage procedure for patients with UPJO complicated with kidney stones, including a first-stage laparoscopic pyeloplasty for UPJO and secondstage percutaneous nephroscopy for kidney stones, is effective, but this increases the medical costs to the patient significantly.…”

Section: Discussionmentioning

confidence: 99%

“…UPJO complicated with kidney stones is difficult to treat surgically. Surgical methods for treating UPJO complicated by kidney stones include open surgery, percutaneous nephrolithotomy (PNL) with endopyelotomy, retroperitoneoscopic or laparoscopic robot-assisted pyeloplasty with flexible or rigid scopes, and simultaneous or staged surgery (4,5). In the past, PNL with endopyelotomy was the preferred treatment, but its long-term efficacy is unsatisfactory (6).…”

Section: Introductionmentioning

confidence: 99%

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Retroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope: Our initial experience at a single centre

Zhang

Wang²,

Gao³

et al. 2022

Front. Surg.

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PurposeWe present our experience with retroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope in patients with ureteropelvic junction obstruction(UPJO) complicated with kidney stones.Materials and MethodsThe records of 37 patients who underwent retroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope to manage UPJO complicated with kidney stones from July 2015 to December 2020 were retrospectively reviewed. All patients underwent one-stage retroperitoneoscopic pyeloplasty combined with flexible cystoscopic pyelolithotomy. The operative time, blood volume, stone clearance rate, length of hospital stay, complications and follow-up events were recorded.ResultsThe operation went smoothly in all 37 patients. The mean operative time was 148.4 ± 24.2 min. The mean intraoperative blood loss volume was 54.3 ± 20.5 ml. The mean hospitalization time was 10.6 ± 3.7 days. The stone clearance rate was 81.08%. The mean follow-up period was 23.5 months (range 12–53 months). Hydronephrosis was significantly decreased in 33 of the 37 cases. The success rate of the operation was 89.19%. Stones recurred in 9 patients during follow-up, for a recurrence rate of 24.32%.ConclusionRetroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope in patients with UPJO complicated with kidney stones is safe, effective and worthy of promotion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope: Our initial experience at a single centre

Zhang

Wang²,

Gao³

et al. 2022

Front. Surg.

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“…Among the minimally invasive procedures PCNL has statistically significant shorter operative time, lower mean drop of haemoglobin as well as stone free rate. 2 Prone PCNL was first described by Fernström and Johansson 3 in 1976. Since then it has been considered to be the gold standard treatment for large kidney stones of size ⩾2 cm.…”

Section: Introductionmentioning

confidence: 99%

Calcutta position: A new modified supine decubitus for supine PCNL

Choudhury,

Sinha Roy,

Pal

2023

Urologia

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Introduction: PCNL (percutaneous nephrolithotripsy) is considered the gold standard treatment for renal stone more than 2 cm. In today’s scenario, supine PCNL is considered equally effective as prone PCNL. The ideal position for supine PCNL is still debatable. We hereby describe our initial experiences of supine PCNL in a novel position. Methods and materials: This prospective study includes 60 patients who underwent supine PCNL in the ‘Calcutta position’ in our institute from August 2021 to August 2022. Successful procedure was defined as a complete stone free rate or a clinically insignificant residual stone (<4 mm). Results: Average Operative room (OR) occupancy time was 130.9 ± 19.63 min. The immediate stone free rate was 84.2%, 71.4% and 37.5% for single, multiple and staghorn calculus respectively. Complications include fever, requirement of blood transfusions and renal colic. The average hospital stay was 83.6 ± 17.42 h. Eight patients (13.3%) required secondary procedures like extracorporeal shock wave lithotripsy (ESWL) or relook PCNL. At 3 months average stone free rates were 92%, 85%, 75% for single, multiple and staghorn calculus respectively. We performed supine PCNL in Calcutta position in obese, kyphoscoliosis, poliomyelitis, autosomal polycystic kidney disease (ADPKD), malrotated kidney and diverticular stone with comparable success. Conclusion: Supine PCNL in Calcutta position is a safe and effective option for nephrolithiasis management. Apart from the inherent advantages of supine PCNL it also has the advantages of better C-Arm and nephroscope manoeuvrability. Supine PCNL in Calcutta position was performed in a variety of scenarios with comparable results.

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“…RIRS offers several benefits over PCNL, such as reduced risk of bleeding and shorter hospital stays [ 12 ]. Although PCNL and RAPL are safe and efficient methods of managing large renal stones, they are associated with a significantly higher mean estimated blood loss when compared with PCNL; furthermore, the stone-free rate is lower [ 13 ]. Despite increasing acceptance of these parenchymal injury-free surgical methods among urologists in recent years, few studies have directly compared these methods.…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm

Yeh,

Weng,

Lin

et al. 2023

Medicina

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Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.

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The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis

Cited by 16 publications

References 36 publications

Retroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope: Our initial experience at a single centre

Retroperitoneoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible cystoscope: Our initial experience at a single centre

Calcutta position: A new modified supine decubitus for supine PCNL

Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm

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