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Ahmadi A, Al Rashed AA, Ebrahim SH, Hasan O, Alaradi H, Abdulaziz K, Jalal A, Awad N. Laparoscopy-Assisted Percutaneous Nephrolithotripsy (PCNL) in Ectopic Pelvic Kidney. Cureus 2022; 14:e26928. [PMID: 35989799 PMCID: PMC9379214 DOI: 10.7759/cureus.26928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/29/2022] Open
Abstract
An ectopic kidney is a rare developmental anomaly in which the kidney can be pelvic, iliac, abdominal, and thoracic, and affected patients are more prone to conditions such as reflux, pelvic ureteric junction (PUJ) obstruction, hydronephrosis, nephrolithiasis, and even renal failure than patients with normally structured kidneys. In this case, we present a 43-year-old male who is a known case of ectopic left pelvic kidney and presented with chronic lower abdominal pain. Upon imaging, it was revealed that he had a staghorn stone for which he underwent laparoscopy-assisted percutaneous nephrolithotripsy (PCNL). Postoperatively, the patient underwent a quick recovery and was discharged on postoperative day 3 without any perioperative complications. Hence given our experience with this case and the similar experiences of urologists over time, the use of laparoscopy-assisted PCNL appears to create a safe way of entering the abdomen and locating the ectopic kidney as well as provide visual guidance in puncture and dilatation all the while protecting the adjacent structures from harm. This demonstrates that laparoscopy-assisted PCNL is a feasible safe and minimally invasive procedure for patients with ectopic kidneys presenting with large stones.
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Amato M, Piazza P, Deruyver Y, Del Favero L, Van den Broeck T, Sarchi L, Scarcella S, Bravi CA, Puliatti S, Micali S, Van Haute C, Van Cleynenbreugel B. Laparoscopic assisted mini-ECIRS for ectopic kidney lithiasis: A case report and literature review. CEN Case Rep 2022; 11:295-301. [PMID: 34982417 DOI: 10.1007/s13730-021-00683-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Ectopic kidney is a rare anatomic variant with an incidence of about 1 in 900. Renal stones can pose a challenge when a standard approach is not possible. Laparoscopic-assisted endourologic procedure can be a feasible and safe choice. CASE REPORT AND LITERATURE REVIEW We present a case of 32 years old man with spastic quadriplegia, megacolon and pelvic kidney undergoing intervention of laparoscopic-assisted Mini ECIRS for staghorn stone of the left pelvic kidney. To the best of our knowledge, only 59 cases are reported in the literature concerning laparoscopically assisted encdourologic treatment which seems a feasible, safe and adaptable technique in selected complex cases. CONCLUSION Laparoscopic-assisted mini ECIRS is a viable option for the treatment of ectopic kidney stones. This technique should be considered when anatomical anomalies are encountered, to avoid puncture-related complications.
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Affiliation(s)
- Marco Amato
- Department of Urology, University Hospitals Leuven, Leuven, Belgium. .,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. .,ORSI Academy, Melle, Belgium.
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Yves Deruyver
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lina Del Favero
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Simone Scarcella
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Carlo Andrea Bravi
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Carl Van Haute
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Polanco Pujol L, Bueno Chomon G, Caño Velasco J, Rodríguez Fernández E, Diez-Cordero JM, Hernández Cavieres J, Blaha I, Hernández Fernández C. Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review. Actas Urol Esp 2021; 45:419-426. [PMID: 34147427 DOI: 10.1016/j.acuroe.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/17/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney. MATERIAL AND METHODS Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: "pelvic ectopic kidney", "ureterorenoscopy", "extracorporeal lithotripsy", "PCNL", "pyelolithotomy". We incluyed original articles, meta-analysis, review and case reports. RESULTS 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85%-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor. CONCLUSION Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.
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Affiliation(s)
- Lucia Polanco Pujol
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Gonzalo Bueno Chomon
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Caño Velasco
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Igor Blaha
- Departamento de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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4
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Polanco L, Bueno G, Caño J, Rodríguez E, Diez-Cordero J, Hernández J, Blaha I, Hernández C. Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review. Actas Urol Esp 2021. [PMID: 33676772 DOI: 10.1016/j.acuro.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney. MATERIAL AND METHODS Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: «pelvic ectopic kidney», «ureterorenoscopy», «extracorporeal lithotripsy», «PCNL», «pyelolithotomy». We included original articles, meta-analysis, review and case reports. RESULTS 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor. CONCLUSION Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.
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5
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Salvi M, Muto G, Tuccio A, Grosso AA, Mari A, Crisci A, Carini M, Minervini A. Active treatment of renal stones in pelvic ectopic kidney: systematic review of literature. MINERVA UROL NEFROL 2020; 72:691-697. [DOI: 10.23736/s0393-2249.20.03792-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y. Management of staghorn stones in special situations. Asian J Urol 2020; 7:130-138. [PMID: 32257806 PMCID: PMC7096693 DOI: 10.1016/j.ajur.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/05/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and solitary kidney. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. The decision should be made individually according to the circumstances of the patient. In this review, we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.
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Affiliation(s)
- Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chaoyue Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Shen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Dong
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Haghighi R, Razi A, Haghighi A, Ebrahimipour N, Teimouri A. Laparoscopy-Assisted Transperitoneal Percutaneous Nephrolithotomy for the Treatment of Renal Stones in a Horseshoe Kidney. Res Rep Urol 2020; 12:49-52. [PMID: 32110553 PMCID: PMC7036982 DOI: 10.2147/rru.s241007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/09/2020] [Indexed: 11/23/2022] Open
Abstract
The objective of this case report is to highlight treatment by LAT-PCNL in a patient with horseshoe kidney. A 51-year-man with hematuria presented to the emergency department with moderate abdominal pain starting 7 hrs ago. He did not report a history of previous urological disease. Renal stone and horseshoe kidney malformation were diagnosed based on the plain abdominal film, intravenous urogram (IVU), non-contrast computed tomography (CT-IVU), and ultrasound findings. Due to the larger stone bulk and renal malformation, it was not possible to perform extracorporeal shock wave lithotripsy (ESWL) monotherapy or ESWL sandwich therapy. Moreover, since percutaneous nephrolithotomy (PCNL) had some challenges and limitations due to high skin-to-stone distance, special anatomy, dispersion stones, and possible consequent internal organs injuries, we performed LAT-PCNL on our patient. We did not observe any perioperative complication. Postoperative control abdominal x-ray revealed only a medium ureteral stone that was extracted while removing the Double-J stent a month later. The patient was discharged on the third postoperative day with normal laboratory values. At 3-month follow-up, the patient was stone-free with normal renal function and renal ultrasonography. Laparoscopy-assisted transperitoneal PCNL seems to be a safe and minimally invasive technique that can be used as an alternative approach in the management of renal stones in special cases of horseshoe kidneys.
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Affiliation(s)
- Ramin Haghighi
- Department of Urology, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran
| | - Abdolah Razi
- Department of Urology, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran
| | - Ashkan Haghighi
- Student Research Committee, North Khorasan University of Medical Sciences, Bojnord, Iran
| | - Navid Ebrahimipour
- Department of Emergency Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran
| | - Ali Teimouri
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Wang C, Jin L, Zhao X, Li G, Xue B. Minimally invasive treatment of an ectopic kidney stone: a case report and literature review. J Int Med Res 2019; 47:4544-4550. [PMID: 31378109 PMCID: PMC6753573 DOI: 10.1177/0300060519865845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An ectopic pelvic kidney is a rare congenital anomaly with a high incidence of
complications such as reflux, hydronephrosis, nephrolithiasis, and even renal
failure. We herein report a case of transperitoneal laparoscopic pyelolithotomy
for treatment of a left pelvic kidney stone and discuss various surgical
procedures based on the published literature. A 64-year-old woman presented to
our hospital with generalized weakness and occasional nonspecific waist pain in
October 2017. Computed tomography showed a 2.6-cm renal pelvis stone located in
the left ectopic pelvic kidney with severe hydronephrosis. The patient underwent
transperitoneal laparoscopic pyelolithotomy and was discharged 7 days after
surgery. Various treatment procedures are available for ectopic kidney stones.
Proper preoperative assessment and selection of the most suitable surgical
procedure play critical roles in successful treatment.
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Affiliation(s)
- Chenglu Wang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Lu Jin
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Xinyang Zhao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Guobin Li
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
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9
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He Z, Zhang C, Zeng G. Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity. Int Braz J Urol 2016; 42:960-966. [PMID: 27509373 PMCID: PMC5066892 DOI: 10.1590/s1677-5538.ibju.2015.0408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/06/2015] [Indexed: 12/12/2022] Open
Abstract
Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.
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Affiliation(s)
- Zhaohui He
- Department of Urology, Minimally Invasive Surgery Center, the first affiliated Hospital of Guangzhou Medical University. Guangdong Key laboratory of Urology Guangzhou, China
| | - Caixia Zhang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, the first affiliated Hospital of Guangzhou Medical University. Guangdong Key laboratory of Urology Guangzhou, China
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10
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Sohail N, Albodour A, Abdelrahman K. Laparoscopic Assisted Transmesocolonic Percutaneous Nephrolithotripsy in Ectopic Iliac Kidney. Urol Case Rep 2016; 7:48-50. [PMID: 27335792 PMCID: PMC4909502 DOI: 10.1016/j.eucr.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/11/2016] [Indexed: 11/03/2022] Open
Abstract
We report a case of 15-year old female who presented with recurrent lower abdominal pain treated three times with ESWL previously. She was diagnosed as having right ectopic kidney with a 4 cm renal stone in renal pelvis and involving lower and mid calyx. She was treated successfully with laparoscopic assisted transmesocolonic percutaneous nephrolithotripsy. Procedure resulted in complete stone clearance without any perioperative or post operative complication. Patient stayed in hospital for 72 h with no drains or stents after day 5, post operatively.
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Affiliation(s)
- N Sohail
- Alkhor Hospital Urology section, Hamad Medical Corporation, Qatar
| | - A Albodour
- Alkhor Hospital Urology section, Hamad Medical Corporation, Qatar
| | - K Abdelrahman
- Alkhor Hospital Urology section, Hamad Medical Corporation, Qatar
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Pastore AL, Palleschi G, Silvestri L, Leto A, Ripoli A, Fuschi A, Al Salhi Y, Autieri D, Petrozza V, Carbone A. Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series. Ther Adv Urol 2016; 8:3-8. [PMID: 26834835 DOI: 10.1177/1756287215607417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. METHODS From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2-9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. RESULTS The average operative time was 140 min (range, 90-190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5-0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2-6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. CONCLUSIONS Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75-100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons.
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Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy
| | - Giovanni Palleschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonino Leto
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Ripoli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Domenico Autieri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
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D'souza N, Verma A, Rai A. Laparoscopic-assisted mini percutaneous nephrolithotomy in the ectopic pelvic kidney: Outcomes with the laser dusting technique. Urol Ann 2016; 8:87-90. [PMID: 26834410 PMCID: PMC4719521 DOI: 10.4103/0974-7796.171499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: The treatment of renal lithiasis has undergone a sea change with the advent of extracorporeal shock wave lithotripsy (ESWL) and endourological procedures such as percutaneous nephrolithotomy (PCNL), ureterorenoscopy and retrograde intrarenal surgery (RIRS). The presence of anatomical anomalies, such as ectopic pelvic kidney, imposes limitations to such therapeutic procedures. This study is aimed to find a simple and effective way to treat the stones in ectopic kidney. Materials and Methods: From 2010 to 2014, nine patients underwent laparoscopic-assisted mini PCNL with Laser dusting for calculi in ectopic pelvic kidneys at our hospital. Retrograde pyelography was done to locate the kidney. Laparoscopy was performed and after mobilizing the bowel and peritoneum, the puncture was made in the kidney and using rigid mini nephroscope, and stones were dusted with Laser. Results: The median interquartile range (IQR) stone size was 18 (6.5) mm. Median (IQR) duration of the procedure was 90 (40) min. The median (IQR) duration of postoperative hospital stay was 4 (2) days. The stone clearance in our series was 88.9%, with only one patient having a residual stone. No intra- or post-operative complications were encountered. Conclusion: Laparoscopy-assisted mini PCNL with Laser dusting offers advantages in ectopic pelvic kidneys in achieving good stone clearance, especially in patients with a large stone burden or failed ESWL or RIRS.
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Affiliation(s)
- Nischith D'souza
- Department of Urology, Yenepoya Medical College and Hospital, Derlakatte, Mangalore, Karnataka, India
| | - Ashish Verma
- Department of Urology, Yenepoya Medical College and Hospital, Derlakatte, Mangalore, Karnataka, India
| | - Avinash Rai
- Department of Urology, Yenepoya Medical College and Hospital, Derlakatte, Mangalore, Karnataka, India
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13
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Soylemez H, Penbegül N, Utangac MM, Dede O, Çakmakçı S, Hatipoglu NK. Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys. Urolithiasis 2015; 44:345-52. [DOI: 10.1007/s00240-015-0829-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/10/2015] [Indexed: 12/15/2022]
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14
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Assimos DG. Re: Percutaneous Nephrolithotomy in Pelvic Kidneys: Is the Ultrasound-Guided Puncture Safe? J Urol 2015; 194:145. [PMID: 26088233 DOI: 10.1016/j.juro.2015.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Resorlu B, Karakan T, Kilinc MF, Kabar M, Doluoglu OG. Laparoscopic-assisted percutaneous nephrolithotomy in malrotated and ectopic pelvic kidneys: calyceal or direct pelvic access? Ren Fail 2015; 37:742-3. [PMID: 25687388 DOI: 10.3109/0886022x.2015.1012982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Berkan Resorlu
- Department of Urology Ankara Training and Research Hospital Ankara , Turkey
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16
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Prakash J, Swami V, Singh BP, Sankhwar S. Large stone in crossed unfused ectopic kidney with totally intrarenal pelvis. BMJ Case Rep 2014; 2014:bcr-2013-200713. [PMID: 24825550 DOI: 10.1136/bcr-2013-200713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jai Prakash
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vimala Swami
- Department of Dental, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Bhupendra Pal Singh
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Satyanarayan Sankhwar
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
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17
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Mehmet RM, Rustu YF, Hanefi B, Mursel D, Fusun A, Mehmet I. Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review. Ren Fail 2013; 35:1440-4. [PMID: 23991847 DOI: 10.3109/0886022x.2013.828357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.
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Affiliation(s)
- Rifaioglu Murat Mehmet
- Department of Urology, Faculty of Medicine, Mustafa Kemal University , Serinyol, Antakya , Turkey
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Bozkurt IH, Cirakoglu A, Ozer S. Retroperitoneal laparoscopic pyelolithotomy in an ectopic pelvic kidney. JSLS 2013; 16:325-8. [PMID: 23477189 PMCID: PMC3481231 DOI: 10.4293/108680812x13427982376707] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Retroperitoneal laparoscopic pyelolithotomy was performed in an ectopic pelvic kidney with renal pelvis calculi. METHODS AND RESULTS Laparoscopic pyelolithotomy was successfully performed in an ectopic pelvic kidney by using the retroperitoneal route. The total operation time was 130 minutes, and the estimated blood loss was < 50 mL. The patient was discharged on the second postoperative day without any complications. CONCLUSION Laparoscopic pyelolithotomy is an effective treatment option for management of stones in the pelvis of an ectopic pelvic kidney. The retroperitoneal route may help to avoid intraoperative and postoperative complications.
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Alomar M, Alenezi H. Computed tomography-guided transgluteal percutaneous nephrolithotripsy in an ectopic pelvic kidney: novel technique. J Endourol 2013; 27:398-401. [PMID: 23094671 DOI: 10.1089/end.2012.0464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Management of stones in the ectopic pelvic kidney can be very challenging. Treatment of each patient should be individualized. We describe a new approach that is CT-guided transgluteal percutaneous nephrolithotripsy (PCNL). CASE AND TECHNIQUE A 19-year-old male presented with symptomatic right ectopic pelvic kidney stones. He was treated with CT-guided transgluteal PCNL. The patient was stone free at postoperative day 1. No major complications were observed, and the patient was discharged home on postoperative day 2. CONCLUSION CT-guided transgluteal PCNL is a safe and effective option for selected patients with ectopic pelvic kidney stones.
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Affiliation(s)
- Mohammad Alomar
- Urology Division, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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Simforoosh N, Radfar MH, Nouralizadeh A, Tabibi A, Basiri A, Mohsen Ziaee SA, Sarhangnejad R, Abedinzadeh M. Laparoscopic anatrophic nephrolithotomy for management of staghorn renal calculi. J Laparoendosc Adv Surg Tech A 2013; 23:306-10. [PMID: 23448123 DOI: 10.1089/lap.2012.0275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Management of staghorn renal stones is still challenging. We present our experience with laparoscopic anatrophic nephrolithotomy as an alternative option for management of staghorn renal calculi. PATIENTS AND METHODS Twenty-four patients with staghorn renal calculi underwent 25 laparoscopic anatrophic nephrolithtomy procedures. Characteristics of patients and stones along with perioperative features such as operation time, transfusion, ischemic time, hospitalization, stone-free rate, and biochemical data were recorded prospectively. We applied the one-layer knotless technique for renorrhaphy repair. RESULTS The mean age of the patients was 55.1 ± 10.9 years (range, 28-74 years). Eleven (44%) operations were done on the right side, and 14 (56%) were done on the left side. Complete and partial staghorn stones existed in 17 (68%) and 8 (32%) renal units, respectively. The mean stone size was 61.5 ± 11.5 mm. Ischemic time was 30.4 ± 7.55 minutes. The stone-free rate was 88% on discharge and 92% after one session of extracorporeal shockwave lithotripsy. CONCLUSIONS Although percutaneous nephrolithotomy is the standard of care for treatment of staghorn stone, laparoscopic anatrophic nephrolithotomy seems to be a safe and feasible option in select patients.
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Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran.
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21
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Tepeler A, Silay MS, Armagan A, Basibuyuk I, Akman T, Akcay M, Onol SY. Laparoscopic-assisted "microperc" of a stone in a pelvic kidney of a 3-year-old girl. J Laparoendosc Adv Surg Tech A 2012; 23:174-6. [PMID: 23157323 DOI: 10.1089/lap.2012.0270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Treatment of kidney stones in pelvic ectopic kidneys of children is a challenging procedure for urologists. Herein we report a case of laparoscopy-assisted "microperc" in a 3-year-old girl with a stone in her pelvic ectopic kidney. This micro-optical system is helpful in confirming the percutaneous access and provides the possibility of fragmenting the stone without the necessity of dilating the tract.
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Affiliation(s)
- Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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Richard P, Bettez M, Martel A, Ponsot Y, Sabbagh R. Laparoscopic management of a large staghorn stone. Can Urol Assoc J 2012; 6:E121-4. [PMID: 22709883 DOI: 10.5489/cuaj.11027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urinary calculi are prevalent and result in significant morbidity, with a marked economic impact. Various therapeutic options exist, from medical to surgical management according to stone size. Laparoscopic pyelolithotomy is a viable option for significant staghorn renal stones. We report the case of a laparoscopic pyelolithotomy performed on a 48-year-old man with a left recurrent staghorn renal stone secondary to an ureteropelvic junction obstruction following a grade IV renal trauma several years ago.
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Affiliation(s)
- Patrick Richard
- Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, QC
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23
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Ganpule AP, Prashant J, Desai MR. Laparoscopic and robot-assisted surgery in the management of urinary lithiasis. Arab J Urol 2012; 10:32-9. [PMID: 26558002 PMCID: PMC4442910 DOI: 10.1016/j.aju.2011.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 01/19/2023] Open
Abstract
Objectives To review the current role of laparoscopy and robot-assisted laparoscopy for managing urinary lithiasis. Results The contemporary indications for laparoscopic stone management are: anatomical variations in location or shape of the kidney (pelvic kidney, horseshoe kidney and malrotated kidney); coexisting pathologies, e.g. pelvi-ureteric junction obstruction; and stones in a renal unit with lower ureteric obstruction. The laparoscopic approach allows the simultaneous management of both the pathologies. Symptomatic stones in diverticula not amenable to endourological intervention can be treated with laparoscopy. Large impacted pelvic and ureteric calculi with a functioning renal unit are an indication for laparoscopic ureterolithotomy or pyelolithotomy. This review of current reports suggests that in a selected group of patients with complex stone disease the laparoscopic approach offers good success rates with minimal complications. There are few reports of robotic procedures in stone disease but existing data suggest that it is feasible. Conclusion Laparoscopic surgery is effective for complex renal stones and offers excellent stone clearance rates with minimal morbidity. Laparoscopic surgery is complementary in managing these stones. Robot-assisted laparoscopic technique of urinary tract stone management is in its early stage of implementation and randomised trials that compare robot assisted outcomes with other minimally invasive techniques are needed.
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Affiliation(s)
| | - Jain Prashant
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh R Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Laparoscopic Transperitoneal Pyelolithotomy for Management of Staghorn Renal Calculi. J Laparoendosc Adv Surg Tech A 2012; 22:61-5. [DOI: 10.1089/lap.2011.0302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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El-Nahas AR, Shokeir AA. Minimally Invasive Treatment of Calculi in Renal Anomalies. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rais-Bahrami S, Friedlander JI, Duty BD, Okeke Z, Smith AD. Difficulties with access in percutaneous renal surgery. Ther Adv Urol 2011; 3:59-68. [PMID: 21869906 DOI: 10.1177/1756287211400661] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Percutaneous renal surgery provides a minimally invasive approach to the kidney for stone extraction in a number of different clinical scenarios. Certain clinical cases present inherent challenges to percutaneous access to the kidney. Herein, we present scenarios in which obtaining and/or maintaining percutaneous access is difficult along with techniques to overcome the challenges commonly encountered. Also, complications associated with these challenging percutaneous renal surgeries are discussed.
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Affiliation(s)
- Soroush Rais-Bahrami
- North Shore Long Island Jewish Health System, The Arthur Smith Institute for Urology, 450 Lakeville Road, New Hyde Park, NY 11040, USA
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Herati AS, Atalla MA, Kavoussi LR. The Electric Kool-Aid Acid Test: an allegory of surgical progress. BJU Int 2010; 106:887-91. [PMID: 20883239 DOI: 10.1111/j.1464-410x.2010.09664.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Amin S Herati
- Smith Institute for Urology, North Shore, NY 11042, USA
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29
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Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta. ACTA ACUST UNITED AC 2010; 39:73-6. [PMID: 20229321 DOI: 10.1007/s00240-010-0263-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
Abstract
Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the right kidney and grade 1-2 hydronephrosis at the same side with normal kidney functions and severe left-sided scoliosis were detected. After explanation of risks of the treatment modality and general anesthesia to the patient, extraperitoneal laparoscopy-assisted PCNL was performed. No complications occurred due to general anesthesia or surgical procedure. The operation time was 95 min and no blood transfusion was required. The nephrostomy tube and retroperitoneal drain were removed 2 and 3 days after the procedure, respectively. The patient was doing well at a follow-up of 6 months. Extraperitoneal laparoscopy-assisted PCNL approach may decrease the risk of surgery as an alternative treatment modality for OI patients. Such cases should be operated on at centers with significant experience in the field of endourology, where all the equipment and specialized personnel are readily available.
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Hruza M, Schulze M, Teber D, Gözen AS, Rassweiler JJ. Laparoscopic Techniques for Removal of Renal and Ureteral Calculi. J Endourol 2009; 23:1713-8. [PMID: 19785553 DOI: 10.1089/end.2009.1539] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcel Hruza
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Michael Schulze
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Dogu Teber
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Jens Jochen Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
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Retroperitoneal laparoscopic pyelolithotomy: how does it compare with percutaneous nephrolithotomy for larger stones? MINIM INVASIV THER 2009; 10:105-9. [PMID: 16753999 DOI: 10.1080/13645700152601405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.
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Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic Gil-Vernet pyelolithotomy: An initial report. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709409152997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Vincent G Bird
- Department of Urology, Miller School of Medicine, University of Miami, Dominion Tower, Miami, FL 33136, USA.
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Laparoscopy-assisted tubeless percutaneous nephrolithotomy in previously operated ectopic pelvic kidney with fragmented J–J stent. ACTA ACUST UNITED AC 2009; 37:257-60. [DOI: 10.1007/s00240-009-0205-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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35
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Gupta N, Mishra S, Seth A, Anand A. Percutaneous Nephrolithotomy in Abnormal Kidneys: Single-Center Experience. Urology 2009; 73:710-4; discussion 714-5. [DOI: 10.1016/j.urology.2008.10.070] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 10/01/2008] [Accepted: 10/24/2008] [Indexed: 11/25/2022]
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Lithiase urinaire et laparoscopie. Traitement des calculs du rein (hors anomalies fonctionnelles ou anatomiques). Prog Urol 2008; 18:938-42. [DOI: 10.1016/j.purol.2008.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 11/30/2022]
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Mousavi-Bahar SH, Amir-Zargar MA, Gholamrezaie HR. Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys. Int J Urol 2008; 15:276-8. [PMID: 18304232 DOI: 10.1111/j.1442-2042.2007.01985.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Abstract
INTRODUCTION The increasing spread and technical enhancement of endourological methods has led to displacement of the surgical therapy of renal and ureteral calculi. MATERIALS AND METHODS Based on a review of current literature, we describe indications, technique, and clinical importance of the open and laparoscopic management of urolithiasis. RESULTS In Europe and North America, the surgical therapy of urolithiasis only plays a role in cases of very large or hard stones, after failure of shock wave lithotripsy, percutaneous nephrolithotripsy, or ureteroscopic stone removal, and in cases of abnormal renal anatomy, i.e., only in a few percent of all stone therapies. However, in developing countries and emerging markets with different structure and funding of the health care system where the methods of endourology are not readily available, these techniques still have a higher importance. Particularly in Europe, laparoscopic surgery is emerging because calculi can be removed from almost all locations in the kidney and ureter using a transperitoneal or retroperitoneal access. Functional outcomes and complication rates are comparable. The benefits of laparoscopy are less postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. CONCLUSIONS Although procedures for open and laparoscopic removal of renal and ureteral calculi are only performed in rare cases in daily urological practice, they are superior to the endourological techniques in some circumstances. Therefore, they should still be part of the urologist's skills.
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Abstract
BACKGROUND AND PURPOSE Laparoscopic pyelolithotomy, although uncommonly performed, may be considered in patients who have renal anomalies, are poorly compliant, and have a large single renal-pelvic calculus. We present our experience with this procedure in five patients. PATIENTS AND METHODS Three patients underwent laparoscopic pyelolithotomy because of a horseshoe kidney, one for a pelvic kidney, and one for a large renal-pelvic calculus. All stones were solitary with a mean size of 2280 mm2 (range 540-8200 mm2). All were approached transperitoneally with passage of a flexible cystoscope through a laparoscopic port to aid in stone extraction. RESULTS All cases were completed laparoscopically. The length of surgery was 74, 92, 134, 158, and 159 minutes. There were no minor or major complications, and the estimated blood loss was <50 mL in all cases. All patients were discharged on postoperative day 1 with the drains removed. Four patients were stented for 4 to 6 weeks. The remaining patient was not stented because of poor compliance. The stents were removed with office cystoscopy. All patients were stone free on follow-up imaging. CONCLUSIONS Laparoscopic pyelolithotomy can be done safely, effectively, and efficiently with proper patient selection and adherence to standard laparoscopic surgical principles.
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Affiliation(s)
- Brandan A Kramer
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9665, USA
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40
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Cinman NM, Okeke Z, Smith AD. Pelvic kidney: associated diseases and treatment. J Endourol 2007; 21:836-42. [PMID: 17867938 DOI: 10.1089/end.2007.9945] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The incidence of pelvic kidney has been approximated at between 1 in 2200 and 1 in 3000. The ectopic kidney is thought to be no more susceptible to disease than the normally positioned kidney, except for the development of calculi and hydronephrosis. Because of the greater risk of injuring aberrant vessels or overlying abdominal viscera and nerves, the pelvic kidney presents special treatment challenges. Alternative approaches to treating nephrolithiasis may yield better outcomes. The tortuous ureter often associated with a pelvic kidney hinders deflection of the flexible ureteroscope, potentially limiting access. Laparoscopy-guided intervention permits visual exposure of the kidney, enhancing safe puncture and tract placement integral to percutaneous nephrolithotomy. Laparoscopy-assisted anterior retrograde percutaneous nephroscopy involves percutaneous access using a Hunter-Hawkins retrograde nephrostomy needle with adjunctive laparoscopy to permit viewing and manipulation of overlying bowel. Ureteropelvic junction (UPJ) obstruction has been reported to occur in 22% to 37% of ectopic kidneys. Endoscopic incision presents difficulties beyond those of anatomically normal kidneys. The laparoscopic approach provides good surgical exposure, and operative times are comparable to those of laparoscopic pyeloplasty in anatomically normal kidneys. To date, only a handful of cases of malignancy in a pelvic kidney have been described. Like a nonfunctioning anatomically normal kidney, a nonfunctional pelvic kidney may require primary removal. There are a few reports of laparoscopic pelvic nephrectomy. Additional studies are needed to compare the various treatments for disease of the pelvic kidney in order to decide which options have the most beneficial outcomes.
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Affiliation(s)
- Nadya M Cinman
- Department of Urology, North-Shore Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA
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41
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Combination of Laparoscopy and Nephroscopy for Treatment of Stones in Pelvic Ectopic Kidneys. J Endourol 2007; 21:1131-6. [DOI: 10.1089/end.2007.9930] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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42
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Mosavi-Bahar SH, Amirzargar MA, Rahnavardi M, Moghaddam SMH, Babbolhavaeji H, Amirhasani S. Percutaneous Nephrolithotomy in Patients with Kidney Malformations. J Endourol 2007; 21:520-4. [PMID: 17523906 DOI: 10.1089/end.2006.0349] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Stein RJ, Desai MM. Management of urolithiasis in the congenitally abnormal kidney (horseshoe and ectopic). Curr Opin Urol 2007; 17:125-31. [PMID: 17285023 DOI: 10.1097/mou.0b013e328028fe20] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Robert J Stein
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Khan F, Borin JF, Pearle MS, McDougall EM, Clayman RV. Endoscopically guided percutaneous renal access: "seeing is believing". J Endourol 2006; 20:451-5; discussion 455. [PMID: 16859452 DOI: 10.1089/end.2006.20.451] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Image-guided percutaneous nephrostomy tube placement can be a challenging procedure, particularly in a nondilated system or in the morbidly obese patient. Herein, we report the routine use of ureteroscopy-guided percutaneous renal access. With this method, rapid, accurate creation and dilation of the nephrostomy tract is assured in all patients regardless of body habitus or stone burden.
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Affiliation(s)
- Farhan Khan
- Department of Urology, University of California, Irvine, Orange, California 92868, USA
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Abstract
PURPOSE OF REVIEW Congenital abnormities in urology are very common. Horseshoe, malrotated and ectopic kidneys, as well as duplex systems, are the most frequent in this respect. The combination of both abnormalities and stones is of clinical importance. The question is asked if standard procedures for stones apply also to stones in abnormal kidneys. RECENT FINDINGS In general, open surgery, extracorporeal shock-wave lithotripsy, percutaneous procedures, endoscopic procedures and laparoscopy are possible procedures in both normal and abnormal kidneys. The importance of ureteric pelvic junction obstruction has to be taken into account and a metabolic work-up remains important. SUMMARY The trend for treatment of stones in abnormal kidneys goes towards endoscopical and laparoscopical procedures, whereas a combination of both seems to be appropriate in many cases.
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Matlaga BR, Kim SC, Watkins SL, Kuo RL, Munch LC, Lingeman JE. Percutaneous nephrolithotomy for ectopic kidneys: over, around, or through. Urology 2006; 67:513-7. [PMID: 16504255 DOI: 10.1016/j.urology.2005.09.056] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 09/02/2005] [Accepted: 09/29/2005] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Brian R Matlaga
- Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, Kidney Stone Institute, Indianapolis, Indiana, USA
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Goel R, Yadav R, Gupta NP, Aron M. Laparoscopic Assisted Percutaneous Nephrolithotomy (PCNL) in Ectopic Kidneys: Two Different Techniques. Int Urol Nephrol 2006; 38:75-8. [PMID: 16502056 DOI: 10.1007/s11255-005-3611-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Two patients presented with calculi in ectopic kidneys. Complete clearance of calculi was achieved by laparoscopic assisted percutaneous nephrolithotomy (PCNL), by different but related techniques. In one patient with prior history of open pyelolithotomy, the anterior surface of the kidney was exposed by mobilizing the overlying sigmoid colon laparoscopically and the percutaneous tract was established into the desired calyx under combined laparoscopic and fluoroscopic control. In the second patient, the tract was established between the major mesenteric vessels without any mobilization of the bowel. Herein, we outline the nuances of these two related techniques, and the indications and contraindications for their use for laparoscopic assisted PCNL in ectopic kidneys.
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Affiliation(s)
- Rajiv Goel
- Department of Urology, All India Institute of Medical Sciences, 110 029, New Delhi, India
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Yadav R, Kumar R, Hemal AK. Laparoscopy in the management of stone disease of urinary tract. J Minim Access Surg 2005; 1:173-80. [PMID: 21206660 PMCID: PMC3004119 DOI: 10.4103/0972-9941.19264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/15/2005] [Indexed: 11/04/2022] Open
Abstract
As in other fields of urology, the use of minimally invasive techniques has helped decrease the morbidity and convalescence associated with the management of urolithiasis. Laparoscopy has also been used as one of the minimally invasive techniques. This has developed particularly with the increasing experience and use of intracorporeal suturing techniques. However, in comparison with other surgeries, laparoscopy for stone removal is relatively uncommon and we review the current indications, technical limitation and results.
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Affiliation(s)
- Rajiv Yadav
- Department Of Urology, All India Institute Of Medical Sciences, New Delhi-110029
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Nambirajan T, Jeschke S, Albqami N, Abukora F, Leeb K, Janetschek G. Role of laparoscopy in management of renal stones: single-center experience and review of literature. J Endourol 2005; 19:353-9. [PMID: 15865527 DOI: 10.1089/end.2005.19.353] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopy can be an alternative modality in the management of renal stones. We present our experience with laparoscopic renal stone surgery. PATIENTS AND METHODS Eighteen patients (4 males, 14 females) with mean age of 51 years (range 18-86 years) underwent 19 laparoscopic procedures. The mean stone number and size, excluding five patients who had nephrectomy/heminephrectomy, were 1.9 (range 1-5) and 1.3 cm (range 0.5-4.5 cm), respectively. Three patients with ureteropelvic junction obstruction underwent pyeloplasty and concomitant pyelolithotomy. Three patients with upper-pole caliceal-diverticular stones had nephrolithotomy and fulguration of the diverticular mucosa. Three patients with stones and hydrocalix with scarred cortex had partial nephrectomy, two under cold and one under warm ischemia. Five patients, including one with a horseshoe kidney (who had one procedure on each kidney), had pyelolithotomy as an alternative to percutaneous nephrolithotomy. Patients with stones in a nonfunctioning kidney underwent nephrectomy (three patients) or heminephrectomy (one patient). RESULTS All procedures were completed laparoscopically. The operative time was variable depending on the complexity of the procedures, from 115 minutes for Fengerplasty to 315 minutes for partial nephrectomy under cold ischemia (mean 178 minutes). The estimated blood loss was 53.2 mL (range 20-120 ml), and none of the patients received a blood transfusion. Complete stone clearance was achieved in 93% of the procedures. The mean hospital stay was 10.5 days (range 5-35 days). Three patients needed temporary pigtail-catheter drainage for obstruction after pyelolithotomy. One patient with a solitary kidney and infected staghorn calculus had prolonged urinary leak, which stopped with conservative management. One nephrectomy for nephrocutaneous fistula was complicated by a late colonic perforation necessitating colostomy. CONCLUSION Laparoscopic surgery is effective for complex renal stones and allows for adjunctive procedures. It can also be an alternative to percutaneous nephrolithotomy. It complements other minimally invasive procedures, and a need for open stone surgery should be rare in the future.
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Affiliation(s)
- Robert Marcovich
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas 78229-3900, USA.
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