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Objective To present 8 cases of retroperitoneal laparoscopic pyelolithotomy or ureterolithotomy for the treatment of pelvis and ureteral stone. Methods 8 cases of pelvis or ureteral stone have been treated by retroperitoneal laparoscopic pyelolithotomy or ureterolithotomy. The size of the calculi was 0.8～2.4 cm with the incarceration time of 3 months～2 years.Details of the procedure were presented. Results Success has been achieved in all the patients and no complication has been observed during the 3～6 months of follow up. Conclusions Retroperitoneal laparoscopic pyelolithotomy or ureterolithotomy for the treatment of pelvis or ureteral stone is simple ,safe,less traumatic and effective.
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Objective To evaluate the surgical technique and clinical application of retroperitoneal laparoscopic pyelolithotomy and ureterolithotomy with no suture of the incision. Methods Twenty-five patients who had upper urinary tract calculi with the course from 10 months to 6 years were enrolled.The size of the calculi was 1.2 to 3.1 cm in diameter.ESWL was ineffecative in 14 of the patients and ureteroscopic lithotomy failed in 2 of them.Then the 25 patients underwent retroperitoneal laparoscopic pyelolithotomy and ureterolithotomy.Details of the procedure were presented. Results All the operations were successful in the 25 patients. The operations took 60 to 190 min with a mean time of 105 min.All the patients fully recovered with no complication observed during the 9～12 months' follow-up. Conclusions Retroperitoneal laparoscopy surgery with no suture of the incision has advantages of minimal invasive,safe,effective and rapid postoperative rehabilitation.The surgical procedure has a good prospect in the urologic clinical practice.
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Objective To assess the clinical value of retroperitoneoscopic pyelolithotomy (RPPL) and retroperitoneoscopic ureterolithotomy (RPUL) in treating renal pelvis or ureteral calculus. Methods A total of 81 patients with renal pelvis or ureteral calculi underwent RPPL and RPUL on 88 sides. Of them 30 were women and 51 were men. Their age ranged from 12 to 65 years (mean,36 years).The calculi were found on left side in 41 cases,on right side in 33,and on both sides in 7.The calculi were 0.8 to 3.0 cm in diameters.Pyelolithiasis occurred in 11 cases,upper ureteral calculi in 68 cases and middle in 2 cases.Of them 3 had radioparent calculi in ureter.In these patients,21 had experienced unsuccessful ESWL,or ureterorenolithotripsy (URL),or both;2 had undergone conversion to retroperitoneoscopic surgery when the procedure failed in minimally invasive percutaneous nephrolithotomy (MPCNL) or perforation occurred during URL. Results All the stones were completely removed by single procedure.The operation time was between 30 and 210 min with a mean of 65 min.The intra-operative mean bleeding volume was 25 ml (range,10 to 60 ml).30 cases with other urinary tract diseases were cured by retroperitoneoscopic surgery at the same time.The hospital stay was from 4 to 10 days.During the follow-up (1 to 16 months) for the 60 cases,no recurrent calculus was found. Conclusions In selected patients with large,hard,radioparent,chronically impacted pelvis or upper ureteral stones,especially in solitary kidney,RPPL and RPUL may be considered as the first-line treatment and as a salvage procedure for failed ESWL and endoscopy.With these procedures the urinary tract complications can be treated concomitantly.
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Objective: To compare the stone free rate and morbidity of percutaneous nephrolithotomy (PCNL) and open pyelolithotomy for a single renal pelvis stone. Patients and methods: A retrospective study was performed by reviewing case records of patients who underwent stone removal surgery between August 1994 and March 1999. The inclusion criteria was a single renal pelvis stone which was not smaller than 3 cm2 in surface area. Patients in the open pyelolithotomy group who had concurrent nephrotomies were excluded. There were a total of 46 patients of which 25 had undergone PCNL and 21 had undergone pyelolithotomy. Both groups were compared in terms of age, sex, stone surface area, haematocrit, blood urea nitrogen, serum creatinine, operative time, complications, stone free rate, adjunctive procedures, doses of postoperative analgesic injection, length of hospital stay, and time to return to normal work. Statistical analysis was performed by Chi-square test and t-test. Results: Preoperative status of the two groups were similar. The operative time was comparable between the two groups. The stone free rate of the PCNL group and the pyelolithotomy group were 92% and 95% respectively which was not statistically different. Five patients in the PCNL group needed ancillary procedures while only one patient in pyelolithotomy group did. Overall complications of the PCNL group and the pyelolithotomy group were 28.6% and 28% respectively which were comparable. Severe bleeding due to arterio-venous fistula occurred in 2 patients of the PCNL group. However, the complication could be managed successfully by selective embolisation. Disruption of uretero-pelvic junction occurred in one patient of the pyelolithotomy group and was repaired successfully. The number of doses of postoperative pethidine injection to lessen pain was lower in the PCNL group when compared with the pyelolithotomy group (mean 0.96 dose vs 1.95 doses, p<0.003). Length of hospital stay was comparable between the two groups. Time to return to normal work was shorter in the PCNL group when compared with the pyelolithotomy group (mean 13.7 days vs 36.3 days, p<0.001). Conclusions: PCNL is a safe and effective method to treat renal pelvis stones compared to open pyelolithotomy and offers less postoperative discomfort and shorter recovery period.