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2022 Recommendations of The AFU Lithiasis Committee: Open surgery and laparoscopy
1Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris-Cité, Paris, France.
Summary
Laparoscopic and robotic surgery offer whole upper urinary tract stone removal for complex cases. While technically challenging, these methods aim to minimize kidney function loss compared to open surgery.
Area of Science:
- Urology
- Minimally Invasive Surgery
Background:
- Laparoscopic/robotic surgery is used for large (>20mm) and complex upper urinary tract stones in France.
- These techniques are considered after endoscopic failure or for concurrent malformation treatment.
- Key advantages include whole stone removal without fragmentation.
Purpose of the Study:
- To provide recommendations for laparoscopic/robotic upper urinary tract stone removal in the French context.
- To adapt existing European Association of Urology (EAU) guidelines.
Main Methods:
- Recommendations developed using the Clinical Practice Recommendation (CPR) and ADAPTE methods.
- Consideration of EAU Guidelines on urolithiasis (2022).
Main Results:
- Anatomical challenges include intrarenal pelvis and adhesions.
- Complications include urinary fistula and ureteral stenosis, mitigated by double J stenting.
- Struvite stones pose challenges due to friability and potential fragment dispersion.
Conclusions:
- Laparoscopic/robotic surgery offers an alternative for complex upper urinary tract stones.
- Careful technique and stenting are crucial to manage risks.
- Conventional open surgery has higher stone-free rates but greater kidney function loss.
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