Laparoscopically guided transperitoneal percutaneous nephrolithotomy for calculi in pelvic ectopic kidneys

Laparoscopic assisted percutaneous nephrolithotomy in chronic kidney disease patients with ectopic pelvic kidney

Purpose:

Patients with deranged renal functions have a number of associated factors which can impair healing of wound and increase postoperative morbidity. This study was conducted to assess the problems while managing ectopic pelvic kidney calculi using laparoscopic approach for percutaneous nephrolithotomy (PCNL) in chronic kidney disease patients.

Subjects and Methods:

Patients with calculi in ectopic kidney with increased serum creatinine level secondary to obstruction were included in the study. Initially, obstruction was relieved. Patients later underwent laparoscopic-assisted PCNL. Patients were monitored postoperatively.

Results:

Three patients with large renal calculi in ectopic pelvic kidney had presented in 2 years. Laparoscopic-assisted PCNL was done to remove the stone. Patients had persistent urine leak post-operatively. Mean duration for removal of nephrostomy tube and drain removal were 4.67 days and 6.67 days, respectively. These patients also had paralytic ileus for prolonged duration.

Conclusion:

Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.

Outcome of percutaneous nephrolithotomy in anomalous kidney: Is it different?

INTRODUCTION

Various anomalous kidneys such as horseshoe kidney, crossed ectopic kidney, simple ectopic kidney, pelvic ectopic kidney, kidney with duplex system, and malrotated kidney are frequently associated with stone disease. Percutaneous nephrolithotomy (PCNL) is a challenging procedure in these patients because of abnormal orientation of kidney.

PATIENTS AND METHODS

Since 2005-2015, 86 patients underwent PCNL for stone removal in anomalous kidneys. Stone characteristics, type of calyceal puncture, number of punctures, need of relook procedures, mean hemoglobin drop, blood transfusion, mean operative time complications, mean hospital stay, stone free rate, and auxiliary procedure were analyzed.

RESULTS

Totally 91 sessions of PCNL was done in 86 patients including five of horseshoe kidney who had bilateral stone disease. Mean age, duration of symptoms, stone size, and hospital stay was 29.6 ± 12.6 years, 2.18 ± 1.41 years, 4.40 ± 1.16, and 4.17 ± 2.11 days, respectively. Sixteen patients underwent relook procedure, out of which only 6 could have complete stone clearance.

CONCLUSION

PCNL in anomalous kidney is a safe and feasible procedure similar to normally located kidney, but requires careful preoperative planning and intra- and post-operative vigilance.

Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys

Three patients underwent laparoscopic assisted percutaneous nephrolithotomy (PNL). A kidneys, ureter and bladder (KUB), and intravenous pyelogram (IVP) of the first patient showed a 3 cm calculus in a right side ectopic pelvic kidney overlying on the sacrum. The second patient had bilateral ectopic kidneys. The right kidney was located in the true pelvis without calculi and the left kidney was located in the iliac cavity with a 2.5 cm calculus in the renal pelvis. The third one had a 4 cm stone in the infundibulum of the upper calyx of the left pelvic ectopic kidney. All of them had a history of failed shock wave lithotripsy after two sessions. Then the patients were scheduled for laparoscopic assisted percutaneous removal of calculi. Under fluoroscopic control the best access route was located and the kidney was punctured. A 24F nephroscope was introduced and all calculi were disintegrated and removed. Operating time was 150, 120 and 110 min in cases 1, 2 and 3, respectively. Complete stone clearance was documented with a plain X-ray KUB film and ultrasonography. Finally the patients underwent IVP three months following the operation. They were all well and there were no early or late complications.

Percutaneous Nephrolithotomy in Patients with Kidney Malformations

BACKGROUND AND PURPOSE

Percutaneous nephrolithotomy (PCNL) for complex calculi within malformed kidneys can be challenging because of the abnormal anatomy. We present our 7-year experience with PCNL in such patients.

PATIENTS AND METHODS

We performed PCNL on 16 patients with complex calculi and anomalous kidneys, including 7 with horseshoe kidneys, 5 with rotation anomalies, 3 with ectopic kidneys, and 1 with a small kidney. After appropriate preoperative evaluation, the procedure was performed by choosing either anterior or posterior approaches depending on the kidney anomaly. When required, ultrasonography, laparoscopy, or both were used, as well as fluoroscopy to control the procedures.

RESULTS

A single-stage PCNL resulted in complete clearance in 13 patients (81%). A second-look procedure, alone or followed by shockwave lithotripsy, conferred stone clearance in one patient with a malrotated kidney and two with staghorn calculi in horseshoe kidneys. More than one tract was needed in two patients. The procedure was guided by laparoscopy in two patients with calculi in ectopic left kidneys. Serious complications were not encountered.

CONCLUSION

Patients with malformed kidneys and complex calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation.

Management of urolithiasis in the congenitally abnormal kidney (horseshoe and ectopic)

PURPOSE OF REVIEW

Urolithiasis in horseshoe and ectopic kidneys presents unique challenges in the decision-making and technical aspects of stone treatment. Specific renal anatomy, stone size and associated conditions such as ureteropelvic junction obstruction are factors that may influence treatment. Detailed review of imaging is important to ensure efficient stone treatment and minimize complications.

RECENT FINDINGS

Widespread use of extracorporeal shockwave lithotripsy for calculi in congenitally abnormal kidneys is now giving way to stone-size and anatomy-appropriate therapeutic decision making. Multiple modalities including shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and laparoscopy are being employed in this group of patients.

SUMMARY

Treatment decisions for stones in horseshoe and ectopic kidneys can be challenging, and must be made on an individual basis taking into account multiple variables.

Is Laparoscopic Approach Safe for Ectopic Pelvic Kidneys?

OBJECTIVE

To assess the feasibility and safety of a laparoscopic approach to pelvic kidneys for ablative and reconstructive surgery.

METHODS

Between January 2002 and February 2005, 6 patients with a left pelvic kidney; 2 with ureteropelvic junction obstruction, 2 with nonfunctioning kidney and 2 with pelvic stones were selected. These patients underwent dismembered pyeloplasty, simple nephrectomy and pyelolithotomy by laparoscopic approach. For pyeloplasty, omitting the prior retrograde stent facilitated dissection around the pelvis, which was identified first and then the ureter was traced downwards. Dismembered pyeloplasty was done by continuous sutures using 4-0 vicryl over a double-J stent placed antegradely. During nephrectomy, the ureter was identified over the iliac vessels and divided first. Subsequent dissection was carried out after lifting the kidney to identify ectopic renal vessels. Pyelolithotomy was performed for a large single pelvic stone after placing the ureteric catheter and confirming the stone's position by fluoroscopy.

RESULTS

One patient with pyelolithotomy was converted to open surgery while the others were completed laparoscopically. Mean hospital stay was 4.16 (range 3-5) days, blood loss 115 (range 30-300) ml and mean operative time was 170 (range 140-220) min. There were no post-operative complications. After pyeloplasty there was significant improvement in renal function and drainage pattern on diuretic scan at 11 and 12 months.

CONCLUSION

The laparoscopic approach provides all the benefits of a minimally invasive procedure to the patients. Due to the different locations of renal vessels, it is safe to approach the ureter first when performing nephrectomy. When performing pyeloplasty, omitting the prior stent placement helps in the identification and dissection of the renal pelvis.

Percutaneous nephrolithotomy for ectopic kidneys: over, around, or through

OBJECTIVES

The treatment of patients with complex urolithiasis in ectopic kidneys can be challenging. Because the location of an ectopic kidney can vary, each case requires a unique and, at times, unconventional approach. We reviewed the techniques we have developed to treat such patients, including laparoscopic-assisted tubeless, transhepatic, and transiliac percutaneous nephrolithotomy (PNL).

METHODS

We performed a retrospective analysis of all patients with congenital pelvic kidneys who underwent PNL at our institution. Six patients underwent laparoscopic-assisted PNL, one underwent transiliac PNL, and one underwent transhepatic PNL. All laparoscopic-assisted procedures were performed tubeless, with an internalized ureteral stent placed at the conclusion of the procedure.

RESULTS

All patients underwent successful PNL. On computed tomography, performed on the morning of postoperative day 1, all patients who underwent laparoscopic-assisted PNL were stone free. The patients who underwent transiliac PNL and transhepatic PNL required secondary procedures to attain a stone-free status. The mean length of hospitalization was 3 days for the laparoscopic-assisted cohort, 1 day for the transhepatic patient, and 3 days for the transiliac patient.

CONCLUSIONS

For the patient with a large or complex stone burden in an ectopic kidney, laparoscopic-assisted PNL is the optimal treatment. Performing such a procedure tubeless may be associated with a reduced hospital stay. For those patients with a hostile peritoneal cavity owing to prior surgical exploration, consideration should be given to a more individualized approach.