Risk Factors for Conversion to Open Surgery in Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis: A
José Iván Robles-Torres1, José Antonio Zapata-González1, Marcos Andrés Sánchez-Rendón1
1Hospital Universitario "Dr. José Eleuterio González," Monterrey, Nuevo León, México.
Journal of Endourology
|March 10, 2025
Summary
Xanthogranulomatous pyelonephritis (XGP) surgery is challenging. Renal abscess and Malek stage III predict conversion to open surgery during laparoscopic nephrectomy for XGP.
Area of Science:
- Urology
- Surgical Oncology
- Pathology
Background:
- Xanthogranulomatous pyelonephritis (XGP) is a rare, severe kidney infection.
- Surgical management of XGP is complex due to inflammation and fibrosis.
- Laparoscopic nephrectomy for XGP has a high rate of conversion to open surgery.
Purpose of the Study:
- To identify risk factors for open conversion in laparoscopic nephrectomy for XGP.
- To evaluate perioperative outcomes of laparoscopic nephrectomy in XGP patients.
Main Methods:
- Multicenter retrospective study of 49 patients undergoing laparoscopic nephrectomy for XGP (2018-2022).
- Analysis of clinical, laboratory, and radiological (Malek classification) parameters.
- Primary outcome: conversion to open surgery; Secondary outcomes: major complications (Clavien-Dindo ≥3) and organ injuries.
Main Results:
- 20.4% of patients required conversion to open surgery.
- Renal abscess (OR: 3.174) and Malek stage III (OR: 14) were independent predictors of conversion.
- Major complications occurred in 26.5%, with colonic and pleural injuries being most common.
Conclusions:
- Laparoscopic nephrectomy for XGP is feasible but technically demanding.
- Renal abscess and advanced disease stage (Malek III) predict conversion to open surgery.
- Laparoscopic approach offers potential benefits in recovery and morbidity despite challenges.
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