[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.