Laparoscopic transperitoneal pyelolithotomy for management of staghorn renal calculi.

BACKGROUND: Recent developments in laparoscopic and retroperitoneoscopic techniques have modified the treatment of renal and ureteral stones. We present the efficacy and possible adverse complications of laparoscopic pyelolithotomy for the treatment of staghorn stones as an alternative to percutaneous nephrolithotomy (PCNL) in our single-surgeon series. PATIENTS AND METHODS: Thirteen patients (10 males and 3 females) underwent transperitoneal laparoscopic pyelolithotomy for removal of staghorn stones. Mean stone size was 5.1 cm (range, 4-6.5 cm). All patients had large stones in the renal pelvis and several (more than two) calices with extrarenal pelvis. RESULTS: Mean operative time was 177 minutes (range, 110-240 minutes), and the mean hospital stay was 4 days (range, 3-7 days). Transfusion was not required in any patient, and open conversion did not happen. Overall success rate was 84.6% (11/13), and 2 patients had residual stones that were managed with extracorporeal shockwave lithotripsy. There were no major complications (bleeding, sepsis, bowel injury, or urinary leakage). CONCLUSION: The role of laparoscopic kidney stone surgery has not been defined well, but laparoscopic transperitoneal pyelolithotomy may be performed with proper results and negligible complications in skillful hands. It could be a suitable alternative to PCNL for the treatment of staghorn stones in selected cases.

The safety and efficacy of percutaneous nephrolithotomy for management of large renal stones in single- versus double-functioning kidney patients.

PURPOSE: To demonstrate the safety and efficacy of percutaneous nephrolithotomy (PCNL) for management of large renal stones between single-functioning kidney and double-kidney patients. PATIENTS AND METHODS: Thirty single-functioning kidneys and 30 double-kidney patients with a mean age of 38.5 (±15.6) years in the single group and 42.1 (±14.3) years in the double group (range 11-72 years) underwent PCNL for renal stones larger than 2 cm. The effect of PCNL on global and regional cortical activity was measured using quantitative single-photon emission CT measurement of technetium-99m ((99m)Tc) dimercaptosuccinic acid (DMSA) scan uptake by the kidneys before and 6 months after PCNL. Variables assessed were stone bulk, size, location, the number of punctures, and anatomic factors. Average hemoglobin and serum creatinine changes, mean operative time, transfusion rate, hospital stay, and different complications were also assessed. RESULTS: Mean stone size, mean hospital stay, success rate, and complications were statistically similar in both groups. Mean serum creatinine changes (preoperative and postoperative) were not statistically significant between the two groups (P=0.12). Mean hemoglobin drop (preoperative and postoperative) in both groups was significant, and there was a valuable difference between them (P=0.01). There was a significant difference in the uptake by the treated kidneys before vs after PCNL between both groups statistically (P=0.019), so that the DMSA renal uptake was obviously higher 6 months after PCNL in the double-kidney group compared with its uptake in the single-functioning kidney group. CONCLUSION: (99m)Tc-DMSA renal scan confirms that renal function was preserved or even often improved after percutaneous stone removal, and the procedure had no detrimental effects on renal function in both groups. There was no statistically significant difference between these groups in terms of morbidity and stone clearance.