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Category: Volume 05 Issue 08 August 2017
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Title: A Comparative study between Retroperitoneoscopic pyelolithotomy and Percutaneous nephrolithotomy in the management of solitary large renal pelvic calculi

Authors: Venugopal G, Manu M K, Avinash T, Vasantharaja R, Rakhul L R, Selvam P

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.06

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.

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Corresponding Author

Manu M K

Additional Professor, Dept of Urology, Trivandrum Medical College, Trivandrum, Kerala- 695011 India

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