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Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
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Laparoscopic pyeloplasty with concomitant pyelolithotomy: technique and outcomes
Robert J Stein1, Burak Turna, Mike M Nguyen
1Department of Urology, Cleveland Clinic, Cleveland, Ohio 44195, USA. steinr@ccf.org
Journal of Endourology
|June 27, 2008
Summary
Laparoscopic pyelolithotomy combined with pyeloplasty is effective for treating kidney stones and ureteropelvic junction obstruction, achieving high stone-free rates without increasing operative time.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Ureteropelvic junction obstruction (UPJO) management can be complicated by coexisting renal calculus disease.
- Laparoscopic pyeloplasty is a standard surgical approach for UPJO.
Purpose of the Study:
- To evaluate the efficacy and outcomes of laparoscopic pyelolithotomy performed concurrently with laparoscopic pyeloplasty.
- To compare outcomes with patients undergoing laparoscopic pyeloplasty alone.
Main Methods:
- Retrospective review of 117 laparoscopic pyeloplasties over 3 years.
- 15 patients underwent concomitant laparoscopic pyelolithotomy using graspers, flexible nephroscopy, or irrigation.
- Comparison with 15 matched controls without stones.
Main Results:
- The overall stone-free rate after laparoscopic pyelolithotomy was 80%.
- Mean operative time was similar between the pyelolithotomy (174 min) and control (170 min) groups (P=0.81).
Conclusions:
- Laparoscopic pyelolithotomy is an efficient procedure for managing concurrent UPJO and renal calculi.
- High stone-free rates are achievable with no significant increase in operative time or morbidity.
- Flexible nephroscopy is occasionally required for stone retrieval.
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