Laparoscopic approach for xanthogranulomatous pyelonephritis and pyonephrosis

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Xanthogranulomatous pyelonephritis (XGPN) is a rare chronic kidney inflammation due to urinary tract obstruction.
• Pyonephrosis is a severe complication of acute obstructive pyelonephritis.
• Minimally invasive surgery offers advantages, but kidney dissection can be challenging.

Purpose of the Study:

• To evaluate the feasibility and outcomes of laparoscopic total nephrectomy for XGPN and pyonephrosis.
• To analyze complications and surgical challenges associated with the laparoscopic approach in these complex cases.

Main Methods:

• A retrospective review of 27 patients who underwent laparoscopic total nephrectomy for XGPN or pyonephrosis between October 2016 and March 2022.
• Utilized the Karl Storz 3D laparoscopic system for all procedures.
• Transperitoneal approach for XGPN and retroperitoneal for pyonephrosis, with all surgeries performed or supervised by a single surgeon.

Main Results:

• Mean operative time was 269.85 minutes, with a mean hemoglobin drop of 1.41 g/dL.
• Difficult dissection occurred in 48.14% of cases; 9/13 were completed intracorporeally, and 4 required conversion to open surgery.
• Complications included one IVC tear, two colon fistulas, one peritoneal breach, and multiorgan resection in 6 cases.

Conclusions:

• Total nephrectomy for XGPN and pyonephrosis is a complex surgical undertaking.
• The laparoscopic approach is viable, with most complications managed intracorporeally.
• This procedure should be reserved for high-volume centers with experienced surgical teams.