Retroperitoneoscopic nephrectomy versus open surgery for non-tuberculous pyonephrotic nonfunctioning kidney: a...

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Obstructive pyonephrotic nonfunctioning kidney (OPNK) frequently necessitates simple nephrectomy due to severe clinical symptoms.
• This study evaluates retroperitoneal laparoscopy versus open surgery for OPNK management.

Purpose of the Study:

• To compare the outcomes of retroperitoneal laparoscopic surgery (LS) and open surgery (OS) for patients with non-tuberculous OPNK.
• To identify patient and disease characteristics influencing surgical approach selection and outcomes.

Main Methods:

• A retrospective analysis of 69 patients with non-tuberculous OPNK (January 2015-June 2019).
• Patients were divided into laparoscopic (N=33) and open surgery (N=36) groups.
• Exclusion criteria included xanthogranulomatous inflammation or tuberculous granuloma; statistical analysis compared demographic, laboratory, and surgical outcome data.

Main Results:

• Non-tuberculous OPNK predominantly affects women (4:1 ratio).
• Open surgery patients exhibited higher preoperative white blood cell (WBC) and neutrophil counts, and a greater incidence of intraoperative hypotension and larger stone size.
• Laparoscopic surgery was associated with significantly shorter postoperative hospitalization, reduced need for retroperitoneal drainage, and lower blood transfusion rates, with less reliance on opioid analgesics post-operatively.

Conclusions:

• Retroperitoneal laparoscopy demonstrates advantages in reduced blood transfusion requirements, surgical drainage duration, and length of hospital stay for OPNK.
• LS is recommended for non-tubercular OPNK when stone load is <280 mm² and preoperative WBC and neutrophil counts are normal.
• These findings support LS as a favorable surgical option for select OPNK patients.