Laparoscopic pyelolithotomy: its current place in the management of renal pelvis stones

Background: Laparoscopic pyelolithotomy is assumed to preserve functional renal parenchyma, and there is a limited risk for immediate or late renal hemorrhage. Therefore, it might be an alternative for the patients in whom maximal preservation of renal parenchyma is necessary. In the present study, we aimed to compare the success rate and perioperative complications of laparoscopic pyelolithotomy. In the present study, we aimed to document and compare the success rate and perioperative complications of laparoscopic pyelolithotomy with published literature about percutaneous nephrolithotomy (PCNL).Methods: We retrospectively reviewed the clinical charts of all patients subjected to laparoscopic pyelolithotomy (18 cases) in the Department of General Surgery at SMIMER Hospital (tertiary care centre), Surat between the period of January 2014 to December 2018. Record of all patients were assessed for demographic profile, co morbidities, routine blood investigations, including RFT, urine cytology and culture sensitivity, specialized investigation as X-ray KUB, USG KUB, IVP/CT-Urography, DTPA scan, all patients were called for follow up evaluation with radiological, clinical and RFT studies at regular intervals upto 3 months.Results: LP is considered a successful alternative therapy for PCNL in selected cases with large renal stones like those in the extra renal pelvis in patients without a history of previous surgery. In addition, laparoscopic pyelolithotomy (LP) can be considered as a reasonable therapeutic option for large staghorn calculus which cannot be removed with a reasonable number of access and sessions of PCNL.Conclusions: Our results show that laparoscopic pyelolithotomy is equally good or better as compared to PCNL in selected cases.

A study to evaluate the outcome following Anderson Hynes pyeloplasty in hydronephrosis patients with cummings stent and D-J stent

Background: Uretero-Pelvic Junction Obstruction (UPJO) is an important cause of hydronephrosis in pediatric age group. The choice of treatment could be conservative or surgical. Commonly Anderson-Hynes pyeloplasty is practiced with internal, external or partly internal partly external stent.Methods: This was a prospective study of 40 patients with UPJO, divided into 2 groups consecutively, each consisting of 20 patients. All patients underwent open Anderson-Hynes pyeloplasty. Cummings stent were given in one group for drainage and conventional DJ stent were used for another group.Results: The mean hospital stay was lesser in DJ stent group (8.4±2.13) compared to Cummings stent group (11.4±0.68), not only in respect to primary admission, but also including readmission for cystoscopic stent removal. The incidence of complications was also fewer in Cumming stent group. Stent migration and urinary tract infection (UTI) were more associated with DJ stent (2 each) than Cumming stent (0 each). However, dysuria was more in case of cumming stent (2 patients) than DJ stent (1 patient).Conclusions: The mean hospital stay in DJ stent insertion is less even if duration for cystoscopic removal is considered. The complication of stent removal and UTI are more with DJ stent though dysuria is more in case of Cummings stent.

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

INTRODUCTION: Robotic Pyeloplasty (RAP) is a technique for management of uretero-pelvic junction obstruction (UPJO). PURPOSE: To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. MATERIALS AND METHODS: Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis including patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications. RESULTS: Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42), 32 were female. Majority were diagnosed with preoperative diuretic renal scintigraphy with obstructed side demonstrating mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as necessitating another procedure due to persistent pain and/or obstruction on diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred. CONCLUSION: RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success as a treatment for primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.

Anderson-Hynes pyeloplasty and double J tube internal drainage for the treatment of pediatric ureteropelvic junction obstruction / 中华泌尿外科杂志

Objective To evaluate the operative treatment of pediatric ureteropelvic junction (UPJ)obstruction. Methods A total of 34 cases of UPJ obstruction in children had double J tubes placed intraoperatively during Anderson Hynes pyeloplasty.Urethral catheterization was maintained for 5～7 days,the double J tube being removed on cystoscopy 4～6 weeks after operation.The outcome was evaluated with ultrasonography or intravenous pelviureterography 3～6 months postoperatively. Results The obstruction was successfully relieved in all the patients and no complications such as urinary infection and leakage of urine were noted on follow up. Conclusions Anderson Hynes pyeloplasty is an effective procedure for the treatment of pediatric UPJ obstruction. The routine use of double J tubes placed intraoperatively can reduce the chance of UPJ restricture and shorten the hospital stay.It is safe and dependable.