Comparison of RLP and PCNL for large pelvis calculi with CKD.

OBJECTIVES: To compare the effect and safety of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for large pelvis calculi with chronic kidney disease (CKD). MATERIAL AND METHODS: Between June 2017 and July 2021, 62 patients with CKD and large renal pelvis calculi (>4 cm2) were treated with RLP. Another 62 patients receiving PCNL served as controls. The perioperative parameters were compared. All patients were followed up for at least 6 months with the stone-free rate and the recovery of renal function evaluated. RESULTS: Significantly longer operation time (101.47 ± 9.25 vs 62.55 ± 7.54 min), less drop in hemoglobin level (0.90 ± 0.38 vs 2.13 ± 0.80 g/dl), staged operations (0% vs 12.9%), postoperative fever (3.23% vs 16.13%) and delayed bowel movement (3.23% vs 14.52), and shorter hospitalization time (3.90 ± 1.66 vs 4.72 ± 1.80 days) were observed in the RLP group (p < 0.05). The stone-free rates were 100% in the RLP group and 88.7% in the PCNL group at the 3-months follow-up (p < 0.05). The serum creatinine level was significantly lower in the RLP group at 24 h (2.81 ± 1.18 vs 3.00 ± 1.15 mg/dl) and 1 week (2.08 ± 1.13 vs 2.34 ± 1.01 mg/dl) postoperatively (p < 0.05). CONCLUSIONS: Although associated with a longer operation time, RLP is a safer and more efficient surgical option for CKD patients with large pelvic stones than PCNL.

Is laparoscopic pyelolithotomy an alternative to percutaneous nephrolithotomy for treatment of kidney stones larger than 2.5 cm in pediatric patients?

PURPOSE: The aim was to compare laparoscopic pyelolithotomy and percutaneous nephrolithotomy in terms of efficacy and safety for the treatment of renal pelvis stones larger than 2.5 cm in pediatric patients. METHODS: Our study consisted of two groups. Group 1 included 33 patients who underwent laparoscopic pyelolithotomy (LPL) between January 2013 and March 2022, and group 2 included 39 patients who underwent percutaneous nephrolithotomy (PCNL). The basic clinical parameters of the patients were recorded. Mean operation time, stone size, estimated blood loss, blood transfusion rate, postoperative hospital stay, stone-free rate, postoperative analgesia requirements, intraoperative complications, and early and late postoperative complications were compared between the two groups. RESULTS: In our study, the mean age of the patients in groups 1 and 2 was 8.89 ± 1.58 years and 9.1 ± 1.85 years, respectively (p = 0.657). The mean stone size was 2.37 ± 0.38 cm in group 1 and 2.55 ± 0.45 cm in group 2 (p = 0.64). The mean operation time was 85.65 ± 20.55 min in group 1, while it was 76.11 ± 13.12 min in group 2 (p = 0.08). The stone-free rate was 100% in both groups. Intraoperative mean blood loss, need for postoperative analgesia, blood transfusion and intraoperative complication rates were significantly higher in the PCNL group (p < 0.01, p = 0.02, p < 0.01, p < 0.01, respectively). CONCLUSION: Our results show that laparoscopic pyelolithotomy is a safe and effective method for pediatric patients with large kidney stones.

Hem-o-Lok clip migration into renal pelvis and stone formation as a long-term complication following laparoscopic pyelolithotomy: a case report and literature review.

BACKGROUND: Hem-o-Lok clips (HOLCs) are widely used in minimal access urological operations due to the advantage of vascular control and suture stabilization. In rare cases, however, they can develop problems themselves. Migration of HOLCs into the collecting system is a fairly rare complication after laparoscopic pyelolithotomy. To date, only two cases were reported in the literature. CASE PRESENTATION: This article describes a case of 51-year-old man with a complaint of left flank pain. He had a medical history of ipsilateral retroperitoneal laparoscopic pyelolithotomy at another hospital 8 years ago. Non-contrast CT scan demonstrated a renal stone in the left ureteropelvic junction complicated by mild hydronephrosis. A straight foreign body was found near the renal pelvis, with part of it wedging into renal pelvic wall. A percutaneous nephrolithotomy (PNL) was performed for this patient. After some fragmentation, a HOLC was found in the kernel of the stone. With an alligator plier, the clip was totally removed out of the collecting system. The postoperative period and follow-up were uneventful. CONCLUSIONS: HOLC migration into renal pelvis is a rare complication following laparoscopic pyelolithotomy. It could act as nidus for stone formation under extended exposure to urine. Using HOLCs to stabilize the anastomotic suture near renal pelvis should be avoided to prevent this complication. Instead, knotting is a better choice under such condition. The secondary calculi and dislodged HOLCs can be removed through PNL by an alligator plier after laser lithotripsy.

Laparoscopic Surgery in Pediatric Upper Tract Urolithiasis: An Alternate Modality.

INTRODUCTION: Incidence of pediatric urolithiasis has increased over the last few decades. Procedures such as extracorporeal short wave lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopic lithotripsy are not widely available for pediatric age group in many developing countries. It is desirable that advantages of minimally invasive surgery be offered to selected cases with urolithiasis. MATERIALS AND METHODS: All patients with pediatric upper tract urolithiasis managed laparoscopically from January 2015 to April 2020 were retrospectively reviewed. RESULTS: A total of 38 patients were included. The mean age of the patients was 8 ± 2.85 years. Thirty-four patients (renal and upper ureteric) were managed through retroperitoneal approach, while those with lower ureteric calculi (n = 4) were approached transperitoneally. A total of eight patients required conversion to open technique. The stone clearance rate was 79% by laparoscopic approach alone. There were no procedure-related complications. CONCLUSION: Our study suggests that laparoscopic management for pediatric upper tract urolithiasis is a radiation-free, single-time curative treatment and is feasible in centers where facilities for other endoscopic procedures are unavailable.

[Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS: Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

[Unilateral combination of staghorn stone with kidney tumor].

This manuscript provides an overview of the available literature about unilateral combination of nephrolithiasis and renal tumor. Analysis of publications has shown that ipsilateral staghorn calculus and kidney tumors are an extremely rare combination. The majority of these infrequent papers describe case reports where the method of treating such patients is limited by the capabilities and competence of the surgeon or clinic. Despite some messages of favorable outcomes of combined interventions, the effectiveness of simultaneous laparoscopic partial nephrectomy and pyelolithotomy has not been studied, and the technique of this procedure, tactics and criteria for choosing this method are not defined.

Perioperative and long-term results of retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for staghorn calculi: a single-center randomized controlled trial.

PURPOSE: To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi. METHODS: From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups. RESULTS: Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months. CONCLUSIONS: PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.

[A comparative analysis of the results of percutaneous nephrolithotomy and laparoscopic pyelolithotomy].

INTRODUCTION: Percutaneous nephrolithotripsy (PNL) is considered as the main treatment method of patients with large and staghorn kidney stones. In some cases, laparoscopic pyelolithotomy (LP) may be an alternative option to PNL. The aim of our work was to compare the results of these surgical methods for treatment of large pelvis stones. MATERIALS AND METHODS: The results of surgical treatment of 60 patients with large pelvis stones were reviewed. In 40 patients (66.7%) PNL were performed, while in 20 cases (33.3%) LP were done. In the PNL group, the average stone size was 2.7 (2.5-3.8) cm and in the LP group it was 3.0 (2.6-4.2) cm. Four patients in the LP group had kidney malrotation, one patient had pelvic dystopia, and in another case a horseshoe kidney was diagnosed. The operative time and stone-free rate, intra- and postoperative complications, the amount of blood loss and the length of hospitalization were compared. RESULTS: There was no conversion in both groups. There were no significant differences in the mean length of hospitalization (4.5+/-1.5 vs 4.4+/-1.4 days) and analgesic use (2.2+/-0.9 vs 2.4+/-1.0 days) and stone-free rate (100 vs 90%) between groups. The mean operative time was significantly higher at the PL (110.0+/-25.0 vs 65.4+/-24.5 min; p less or equal 0.05), but the amount of blood loss was significantly lower (70+/-28 versus 160.0+/-55 ml; p less or equal 0.05) compared to the PNL group. CONCLUSIONS: PNL remains the main treatment method for patients with large kidney stones. However, abnormal kidneys, concomitant ureteropelvic junction obstruction or endoscopic treatment failure can be indications to LP.

[3D-technologies in planning and navigation for laparoscopic interventions in patients with renal and ureteric stones].

AIM: to evaluate the possibilities and efficiency of using 3D technologies for the laparoscopic interventions in patients with renal and ureteric stones. MATERIALS AND METHODS: A retrospective analysis of the results of surgical treatment of patients with renal and ureteric stones performed in the urology clinic of the I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia for the period from January 2012 to December 2017 was carried out. During this period a total of 4958 interventions were done. Among them, 98 laparoscopic (1.97%) surgeries were performed, including nephron-sparing interventions (n=47; 48%), pyelolithotomy (n=15; 15.3%), ureterolithotomy (n=32; 32.65%) and partial nephrectomy (n=4; 4.05 %). The average patients age was 55.76+/-10.5 (29-80) years. There were 51 men (52%) and 47 women (48%). The mean stone density was 1237.6+/-354.6 HU (from 500 to 1913 HU). In 14 (22.9%) cases, nephrostomy tube or ureteric stent had been put before surgery. In addition, 40 (40.8%) patients previously underwent one surgical intervention on the kidneys and 17 patients with urinary stone disease (17.3%) underwent surgery more or equal 2 times. 88 (89.8%) patients had severe concomitant diseases and the most common pathology in 51 (52.0%) patients with urinary stone disease was arterial hypertension. In 11 (11.2%) cases, the interventions were performed in patients with abnormal kidneys, including horseshoe kidney (n=6; 6.1%), duplicated collecting system (n=3; 3.1%) and pelvic kidney (n=2; 2%). In addition to standard preoperative diagnostic methods in 22 cases (22.4%) the 3D-planning and multivariate virtual performing of intervention based on the multidetector computer tomography scan was done using Amira 3D-modeling program. Among these patients, virtual interventions were performed prior to all pyelolithotomy and partial nephrectomy. Intraoperative data of virtual constructions were used by surgeons as navigation. The interventions were performed by seven urologists at the clinic with various experience in laparoscopic surgery. RESULTS: The mean duration of laparoscopic pyelolithotomy, laparoscopic partial nephrectomy, laparoscopic ureterolithotomy and laparoscopic nephrectomy was 183.2+/-69.6, 201.3+/-35.2 min, 97.6+/-43.7 and 165.4+/-92.3 min, respectively. The minimal blood loss was observed during laparoscopic ureterolithotomy (53.33+/-31.2 ml). During these interventions, in 8 cases (8.16%) a flexible endoscope was used for inspection and complete removal of stones. Intraoperative complications were noted in 6 patients (6.1%). There were 4 conversions to open surgery (4.1%). Postoperative surgical complications were observed in 1 (1%) patient, while non-surgical complications developed in 4 patients (4.1%). There was no mortality. CONCLUSION: Laparoscopic access for the treatment of patients with urinary stone disease should be used for the treatment of patients with large, long-standing ureteral calculi and patients with kidney stones who have concomitant pathology of kidney or upper urinary tract (UPJ obstruction, kidney tumors) requiring surgical intervention. Laparoscopic access should be considered primarily for the planning of laparoscopic partial nephrectomy and laparoscopic nephrectomy in patients with urinary stone disease. The use of 3D computer-assisted technologies is advisable for patients with urinary stone disease and abnormal kidneys if laparoscopic pyelolithotomy, partial nephrectomy or ureterolithotomy is planned.

Ex vivo stone surgery in donor kidneys at renal transplantation.

OBJECTIVE: To report our experience on the outcomes of ex vivo ureteroscopy and ex vivo pyelolithotomy carried out on the donor kidney before living donor renal transplantation. METHODS: Between 2009 and 2016, 13 stone-bearing donor kidneys underwent ex vivo bench surgery after donor nephrectomy. Of these, six patients underwent ex vivo ureteroscopy and seven patients underwent ex vivo pyelolithotomy. Data were analyzed for technical feasibility, intraoperative and postoperative complications, stone clearance, and stone recurrence. RESULTS: The mean stone burden was 9.1 mm (range 5-15 mm). Renal collecting system access and stone extraction were successfully achieved, and a stone-free status was accomplished with both techniques. The mean duration of ex vivo ureteroscopy was 12.5 min (range 9-20 min), and the mean duration of ex vivo pyelolithotomy was 3.1 min (range 1-8 min). One patient in the pyelolithotomy group developed urinary leakage and underwent surgical repair on the third postoperative day. The mean long-term follow-up duration was 49.6 months (range 14-101 months). None of the 13 patients included in the study suffered from stone recurrence. CONCLUSIONS: Our experience suggests that both ex vivo ureteroscopy and ex vivo pyelolithotomy procedures can safely and effectively be carried out in stone-bearing living donor kidneys, without compromising renal allograft function.

Laparoscopic laser lithotripsy inside the endocatch bag: An alternative technique for removal of large post lap pyelolithotomy calculi.

Large staghorn calculi in unascended pelvic kidneys and in normally located kidneys with anatomy unsuitable for percutaneous nephrolithotomy have to be treated via pyelolithotomy. When performed laparoscopically, the extraction of these staghorn calculi, without extending skin incision at the port site is challenging. We describe the successful use of laparoscopic laser lithotripsy, intracorporeally, with the entrapped calculus inside the endocatch bag, for fragmentation and retrieval without extension of skin incision.

[Characteristic features of urinary calcium excretion and osteoporosis risk factors in patients with urolithiasis].

RELEVANCE: The prevalence of urolithiasis and osteoporosis (OP) indicates that these diseases may be found concurrently in the same patient. The detection of risk factors for OP and disorders of calcium metabolism in patients with urolithiasis is of interest in the context of primary stone formation and metaphylaxis. AIM: To identify risk factors for osteoporosis and disorders of calcium metabolism in patients with urolithiasis. MATERIALS AND METHODS: Osteoporosis risk factors were studied in 45 urolithiasis patients undergoing surgical treatment. Patients were asked to fill out the osteoporosis risk factor questionnaire, and urinary calcium excretion was measured in 24-h collections. RESULTS: Risk factors for osteoporosis were detected in 20 (44.4%) urolithiasis patients. Patients with osteoporosis risk factors identified by the questionnaire were statistically significantly older (p=0.032). Osteoporosis risk factors were found in 20% of patients with newly diagnosed urolithiasis and 24.4% of patients with recurrent urolithiasis. The study patients showed increased urinary calcium excretion and decreased diuresis. The negative correlation between urinary calcium excretion and 24-h diuresis was greater in patients who had than in those who did not have osteoporosis. CONCLUSION: An increase in urinary calcium excretion and a decrease in diuresis can be a predisposing factor for the recurrence of urolithiasis. In patients with risk factors for osteoporosis, it can provide a rationale for administering drugs aimed at preventing stone formation (thiazide diuretics).

Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, laparoscopic pyelolithotomy (LPL) can be used as an alternative management procedure. The aim of present study was to compare LPL and PCNL in terms of efficacy and safety for the management of large renal pelvic stones. METHODS: A literature search was performed in Jan 2016 using electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) to identify relevant studies for the meta-analysis. Only comparative studies investigating LPL versus PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Five randomized and nine non-randomized studies were identified for analysis, involving a total of 901 patients. Compared with PCNL, LPL provided a significantly higher stone-free rate (OR 3.94, 95% CI 2.06-7.55, P < 0.001), lower blood transfusion rate (OR 0.28, 95% CI 0.13-0.61, P = 0.001), lower bleeding rate (OR 0.20, 95% CI 0.06-0.61, P = 0.005), fewer hemoglobin decrease(MD -0.80, 95% CI -0.97 to -0.63, P < 0.001), less postoperative fever (OR 0.38, 95% CI 0.21-0.68; P = 0.001), and lower auxiliary procedure rate (OR 0.24, 95% CI 0.12-0.46, P < 0.001) and re-treatment rate (OR 0.20, 95% CI 0.07-0.55, P = 0.002). However, LPL had a longer operative time and hospital stay. There were no significant differences in conversion to open surgery and prolonged urine leakage rates between LPL and PCNL. CONCLUSIONS: Our present findings suggest that LPL is a safe and effective approach for management of patients with large renal stones. However, PCNL still suitable for most cases and LPL can be used as an alternative management procedure with good selection of cases.

[Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study].

AIM: To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. MATERIALS AND METHODS: A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. INCLUSION CRITERIA: patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. RESULTS: A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. CONCLUSION: In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

[Laparoscopic pyelolithotomy and its role in modern surgery of nephrolithiasis].

AIM: To determine the place of laparoscopic pyelolithotomy in surgical management of nephrolithiasis. MATERIALS AND METHODS: We analyzed 16 laparoscopic pyelolithotomies performed in our clinic over the last few years for large and stag-horn stones of anomalous kidneys (n=8), the "giant" (>30-40 cc) monolithic stones of the large extrarenal pelvis (n=3), multiple stones of PCS with the stone burden of more or equal 40 cm (n=2) and large recurrent (after PCNL) kidney stones in patients at risk of bacteriotoxic complications of percutaneous nephroscopy (n=3). The age of the patients ranged from 39 to 72 years (mean age 51+/-8 years). The average density of stones was 1012 (160-1483) HU. RESULTS: There were no conversions to open surgery. The mean operating time of laparoscopic pyelolithotomy was 137 (96-255) minutes, flexible transabdominal pyelocalycoscopy 31.2 (12-110) min. The stone-free rate was 87%. Residual clinically insignificant stones were found in two (13%) patients with staghorn horseshoe kidney calculi and complex PCS. The preoperative hospital stay was 1 day, postoperative-from 2 to 18 (mean 6) days. DISCUSSION: We believe that laparoscopic pyelolithotomy supplemented by transabdominal flexible pyelocalycoscopy may be recommended for surgical management of patients with "giant", multiple and infected kidney stones, because the length of their percutaneous removal is beyond the recommended time intervals and it is accompanied by an increased risk of septic complications.

Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter >2 cm): a meta-analysis.

OBJECTIVE: To systematically assess the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic calculi >2 cm. METHODS: We searched PubMed, Embase, Cochrane Library, and Google Scholar about LP and PCNL for the treatment of renal stones. The retrieval time ended in September 2015. Two reviewers independently assessed the quality of all included studies. The available data in the studies were analyzed using the RevMan 5.2 software. RESULTS: Four randomized controlled trials (RCTs) and nine Non-Randomized Concurrent Controlled Trials (NRCCTs) were included, involving a total of 766 patients. This meta-analysis showed that LP has a statistically higher stone-free rate than PCNL [I2 = 0, OR = 0.26 (95% CI 0.10-0.64), p = 0.003], lower drop in hemoglobin level [I2 = 0, difference in mean drop = -0.83 (95% CI -1.05 to -0.61), p < 0.00001] and lower postoperation fever [I2 = 0, OR = 0.36 (95% CI 0.14-0.89), p = 0.03], and PCNL is associated with a lower length of hospital stay [I2 = 74%, difference in mean of hospital stay = 0.72 (95% CI 0.04-1.40), p = 0.04]. CONCLUSION: LP is an alternative for the treatment of large solitary renal stone. LP may have a higher stone-free rate, lesser blood loss, lower postoperation fever rate, while PCNL may have a lower length of hospital stay. However, further well designed and large volume randomized controlled trials are needed to confirm these findings.

[The potential of endovideosurgical technologies for simultaneous ipsilateral presentation of a kidney tumor and kidney stone].

AIM: To determine the treatment strategy in patients with kidney tumors co-occurring with ipsilateral kidney stones. MATERIALS AND METHODS: During the period from 2006 to 2015, a combination of kidney tumor and urolithiasis was detected in 159 (11.5%) patients. Of these, 61 patients had indications for surgical treatment for both diseases at the time of hospitalization. The article analyzes the surgical treatment results of 14 patients with ipsilateral combination of kidney stone and kidney tumors and shows the potential of endovideosurgical technologies in managing this category of patients. RESULTS: The surgical treatment for stones was initially conducted in 3 (21.4%) patients, 4 (28.6%) patients underwent the kidney tumor surgery at the first stage, and the remaining 7 (50.0%) patients underwent one-stage surgery for both diseases. Despite the co-occurrence of two pathologies in one kidney, only 2 patients (14.3%) underwent an organ-removing operation. DISCUSSION: Combined minimally invasive organ-sparing surgery for unilateral combination of the kidney stone and kidney tumor is the most preferable treatment option, allowing the patient to get rid of both the tumor and the kidney stone within one anesthesia session. One-stage laparoscopic kidney resection with pyelolithotomy or calycolithoextraction allows preventing possible complications associated with the postoperative stone migration and eliminates the need for repeat surgery.

Transperitoneal Laparoscopic Pyelolithotomy in Pelvic Ectopic Kidneys: Experience From a Northern Indian Tertiary Care Institution.

Introduction The ectopic pelvic kidneys have a higher likelihood of developing renal stones due to urinary stasis caused by the abnormal position of the renal pelvis, altered course of the ureter, and kidney malrotation. This retrospective study highlights the safety, efficacy, and feasibility of performing transperitoneal laparoscopic pyelolithotomy in cases of pelvic ectopic kidney. Methodology The 15 patients with ectopic pelvic kidneys and nephrolithiasis underwent laparoscopic pyelolithotomy. The kidney was exposed either by moving the bowel or using a trans-mesocolic approach. A surgical procedure was performed to remove stones from the renal pelvis using laparoscopic forceps. Following the placement of a double J stent, the incision in the renal pelvis was closed. The procedure was completed after the intraperitoneal drain was inserted. Results A total of 15 patients underwent the transperitoneal laparoscopic pyelolithotomy procedure, with a male-to-female ratio of 3:2. The average age of the patients was 41 (25-58) years, while the average size of the stones was 3.8 cm. Additionally, seven (46.6%) patients had the presence of caliceal stones in conjunction with the pelvic stone. Out of the 15 patients, some had stones on the left side (n = 9, 60%), while others had stones on the right side (n = 6, 40%). The operation with an average duration was 125 minutes with a range of (90-190). Fourteen (93.3%) patients were found to be free of stones. A patient required extracorporeal shock wave lithotripsy (ESWL) to address a small caliceal residual stone measuring 8 mm. After just one session of ESWL, this stone was completely cleared. All stones were successfully removed, resulting in a 100% stone-free rate. Conclusions Laparoscopic pyelolithotomy is a highly effective and efficient procedure for treating large and numerous stones in the ectopic pelvic kidney. This method has a significant level of efficiency in removing stones with limited consequences.

Robotic pyelolithotomy for treating large renal stone disease: a systematic review and single-arm meta-analysis.

Robotic pyelolithotomy continues to gain attention as an alternative to percutaneous nephrolithotomy (PCNL) for managing complex renal stones. We performed a single-arm meta-analysis and systematically searched the English-language literature published in PubMed, Web of Science, Scopus, and Google Scholar databases up to June 2024. The risk of non-randomized bias was assessed using ROBINS-I, and the quality of the literature was assessed using MINORS (Methodological Index for Non-Randomized Studies). Merger parameters were calculated using Stata16/SE under a random-effects model. Five non-comparative single-arm studies were included in the meta-analysis. Results showed that the operative time for robotic pyelolithotomy was 168.10 min (95% CI 133.63, 202.56). The hospital stay was 2.63 days (95% CI 0.96, 4.29), and blood loss was 44.13 ml (95% CI 19.76, 68.51). The stone clearance rate was 87% (95% CI 79-93%). The incidence of minor postoperative complications (Clavien grade I-II) was 23.7% (95% CI 13.4-35.8%), and the incidence of major complications (Clavien grade ≥ III) was 7% (95% CI 0.3-20.7%).The safety and efficacy of robotic pyelolithotomy in treating complex renal stones are acceptable, but future large prospective cohort studies are needed to validate the treatment.

Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis.

PURPOSE: We assessed the effectiveness and safety of laparoscopic pyelolithotomy and percutaneous nephrolithotomy as surgical management for solitary renal pelvic calculi larger than 2 cm. MATERIALS AND METHODS: We searched PubMed®, EMBASE®, The Cochrane Library and the Web of Knowledge(SM) databases up to November 9, 2012 for relevant published studies. After data extraction and quality assessment, meta-analysis was performed using RevMan 5.1. RESULTS: We identified 7 trials in a total of 176 and 187 patients treated with laparoscopic pyelolithotomy and percutaneous nephrolithotomy, respectively. Operative time and hospital stay were 50.62 minutes and 0.66 days shorter in the nephrolithotomy group (p <0.0001 and 0.04, respectively). Patients in the laparoscopic group benefited from a lesser decrease in hemoglobin (OR -1.00, 95% CI -1.77--0.23), less postoperative fever (OR 0.24, 95% CI 0.08-0.72), a lower incidence of bleeding (OR 0.29, 95% CI 0.10-0.85) and a higher stone-free rate (OR 4.85, 95% CI 1.59-14.82). Sensitivity analysis indicated that all results were stable except the stone-free rate showed no statistically significant difference between the 2 groups (OR 0.33, 95% CI 0.09-1.17). No publication bias was detected. CONCLUSIONS: Current evidence suggests that laparoscopic pyelolithotomy and percutaneous nephrolithotomy are effective and safe for large renal pelvic calculi but laparoscopic pyelolithotomy seems to be more advantageous. However, given the inherent limitations of the included studies, results must be further confirmed in high quality randomized, controlled trials.