Abstract
Background: Percutaneous nephrolithotomy (PCNL) is considered gold standard for single large renal pelvic calculi. In this laparoscopic era Retroperitoneoscopic pyelolithotomy (RP) can be considered in selected such patients. The purpose is to compare both modalities in patients with single large renal pelvic calculi.
Materials and Methods: Between September 2015 and February 2017, 80 patients with the diagnosis of solitary renal pelvic calculi of size >2 cm with extra renal pelvis were admitted. Out of which 40 patients underwent RP and 40 patients underwent PCNL. Demographic, preoperative, and postoperative data were collected compared between two groups.
Results: Demographics and mean stone size of two groups were similar. Mean drop in haemoglobin level was significantly lower in the RP (0.52 vs 1.32 g/dl). The mean postoperative hospital stay RP vs PCNL (5.28 vs 4.33 days) was almost similar. Although the operative time in RP group was significantly higher compared to PCNL group (159.13 vs 127.87 min), duration of last 10 cases of RP were similar to PCNL group. Blood transfusion rate (7.5% vs 27.5%), stone free rate (100 vs 92.5%) and postoperative fever rate (10 vs 22.5%) were significantly lower in RP group. None required ancillary procedure for residual fragments in RP group compared to 7.5% in PCNL group.
Conclusion: Retroperitoneoscopic pyelolithotomy can be considered as safe, effective and suitable alternative for conventional PCNL in patients with solitary large renal pelvic calculus with extra renal pelvis. It reduces the post operatively morbidity significantly compared to conventional PCNL.
Keywords: Retroperitoneoscopy, pyelolithotomy, PCNL, large renal calculus.
References
- Stuart Wolf J. Urinary Lithiasis: Percutaneous approaches to the upper urinary tract collecting system. In Wein AJ, Kavoussi LR Campbell-Walsh Urology 10th ed. Philadelphia, Elsevier; 2012. p.1348-54.
- Moskovitz B, Halachmi S, Sopov V, et al. Effect of percutaneous nephrolithotripsy on renal function: assessment with quantitative SPECT of (99m) Tc-DMSA renal scintigraphy. J Endourol. 2006;20:102-6.
- Chatham JR, Dykes TE, Kennon WG, Schwartz BF. Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography. Urology. 2002;59:522-5.
- Unsal A, Koca G, Reşorlu B, Bayindir M, Korkmaz M. Effect of percutaneous nephrolithotomy and tract dilatation methods on renal function: assessment by quantitative single-photon emission computed tomography of technetium-99m-dimer captosuccinic acid uptake by the kidneys. J Endourol. 2010;24:1497-502.
- Bayrak O, Seckiner I, Erturhan SM, Mizrak S, Erbagci A. Analysis of changes in the glomerular filtration rate as measured by the cockroft-gault formula in the early period after percutaneous nephrolithotomy. Korean J Urol. 2012;53:552-5.
- Nouralizadeh A, Sichani MM, Kashi AH. Impacts of percutaneous nephrolithotomy on the estimated glomerular filtration rate during the first few days after surgery. Urol Res. 2011;39:129 33.
- Bilen CY, Inci K, Kocak B, Tan B, Sarikaya S, Sahin A Impact of percutaneous nephrolithotomy on estimated glomerular filtration rate in patients with chronic kidney disease. J Endourol 2008;22:895–900.
- Gaur DD: Retroperitoneal laparoscopy: a simple technique of balloon insertion and establishment of the primary port. Br J Urol.1996;77:458-59.
- Meria P, Milcent S, Desgrandchamps F et al. Management of pelvic stones larger than 20 mm: laparoscopic transperitoneal pyelolitho-tomy or percutaneous nephrolithotomy? Urol Int 2005; 75:322-6.
- Fernström, I., Johansson, B. Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol. 1976; 10:257–259.
- Al-Hunayan A, Abdulhalim H, El-Bakry E, et al. Laparo-scopic pyelolithotomy: Is the retroperitoneal route a betterapproach? Int J Urol 2009;16:181–186.
- Hao, G., Xiao, J., Yang, P. et al, Laparoscopic retroperitoneal dismembered pyeloplasty: single-center experience in China. J Laparoendosc Adv Surg Tech A 2013;23:38–41.
- Hemal AK, Goel A, Kumar M, et al. Evaluation of laparoscopic retroperitoneal surgery in urinary stone disease. J Endourol 2001; 15:701-5.
- Kramer BA, Hammond L, Schwartz BF. Laparoscopic pyelolithotomy: Indications and technique. J Endourol 2007; 21:860-1.
- Sinha R, Sharma N. Retroperitoneal laparoscopic management of urolithiasis. J Laparoendosc Adv Surg Tech A.1997 Apr;7(2):95-8.
- Goel A, Hemal AK. Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with percutaneous nephrolith-otripsy. Int Urol Nephrol 2003; 35:73-6.
- Al-Hunayan A, Khalil M, Hassabo M, Hanafi A, Abdul-Halim H. Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous J Endourol. 2011;25:975-8.
- Wen C, Nakada SY. Treatment selection and outcomes: Renal calculi. Urol Clin North Am 2007; 34:409-19.
- Mariappan P, Smith G, Bariol SV, et al. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: A prospective clinical study. J Urol 2005; 173:1610-4.
Corresponding Author
Manu M K
Additional Professor, Dept of Urology, Trivandrum Medical College, Trivandrum, Kerala- 695011 India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No: +91 9495746829, Landline No: +914712458617
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.06
