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Laparoscopic nephrectomy for urolithiasis: when is better to avoid it.

Alexandre Danilovic1, Thiago Augusto Cunha Ferreira1, Fábio Carvalho Vicentini1

  • 1Universidade de São Paulo, Faculdade de Medicina, Disciplina de Urologia, São Paulo, SP, Brasil.

Revista Do Colegio Brasileiro De Cirurgioes
|June 27, 2019
PubMed
Summary
This summary is machine-generated.

Pararenal abscess and bowel adhesions identified on preoperative CT scans are key risk factors for converting laparoscopic nephrectomy to open surgery for kidney stones. This finding aids in surgical planning for urolithiasis patients.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Medical Imaging

Background:

  • Laparoscopic nephrectomy (LN) is a standard procedure for urolithiasis.
  • Conversion to open surgery can increase morbidity.
  • Identifying predictors of conversion is crucial for patient management.

Purpose of the Study:

  • To investigate risk factors for conversion to open surgery during laparoscopic nephrectomy for urolithiasis.

Main Methods:

  • Retrospective review of 84 patients undergoing LN between 2006 and 2013.
  • Analysis of patient demographics, comorbidities (Charlson's index, ASA score), renal function (MDRD), preoperative CT findings, and complications (Clavien-Dindo).
  • Logistic regression used to identify risk factors for conversion.

Main Results:

  • 19% (16/84) of patients required conversion to open surgery.
  • Primary reasons for conversion included severe adhesions (n=16), bleeding (n=6), and bowel injury (n=3).
  • Multivariate analysis identified pararenal abscess and intestinal adherence as significant risk factors for conversion.

Conclusions:

  • Preoperative CT findings of pararenal abscess and bowel adhesions are significant predictors of conversion during LN for urolithiasis.
  • These factors highlight the importance of detailed preoperative imaging for surgical planning and risk assessment.