Management of Pelvic Stones Larger than 20 mm: Laparoscopic Transperitoneal Pyelolithotomy or Percutaneous Nephrolithotomy?
- 1 December 2005
- journal article
- research article
- Published by S. Karger AG in Urologia Internationalis
- Vol. 75 (4), 322-326
- https://doi.org/10.1159/000089167
Abstract
Large pelvic stones are frequently managed with percutaneous nephrolithotomy (PCNL) but laparoscopic transperitoneal pyelolithotomy (LTP) can be an alternative. We compared PCNL and LTP for the treatment of pelvic stones >20 mm in diameter. Between November 1999 and November 2004, 16 consecutive patients, mean age 42, with a single pelvic stone >20 x 10 mm (group I), underwent LTP as first-line treatment or after shockwave lithotripsy failure. They were compared with a similar population of 16 consecutive patients, mean age 45 (group II), who underwent PCNL for the same indication and were assessed retrospectively. We evaluated operative characteristics, complications, and results for each technique. There was no difference between the two groups regarding the characteristics of patients and stones. Operative time duration was significantly longer in group I (129 vs. 75 min; p = 0.001) and conversion was required in 2 patients (12%). The main postoperative complications were urinary leakage (2 patients, 12%) in group I and bleeding (3 patients, 18%) in group II, but only 1 required blood transfusion. Mean hospital stay was respectively 6.5 and 5.6 days in groups I and II (p = 0.17). Stone-free rates were assessed at 3 months and were not different between group I and group II (88 vs. 82%). The operative time of LTP is longer and the results of both techniques are comparable but postoperative morbidity is different. Specific indications of each technique must be determined although PCNL remains the gold standard for most large pelvic stones.Keywords
This publication has 15 references indexed in Scilit:
- TRANSPERITONEAL LAPAROSCOPIC PYELOLITHOTOMY AFTER FAILED PERCUTANEOUS ACCESS IN THE PEDIATRIC PATIENTJournal of Urology, 2004
- COMBINED ELECTROHYDRAULIC AND HOLMIUM:YAG LASER URETEROSCOPIC NEPHROLITHOTRIPSY FOR 20 TO 40 MM RENAL CALCULIJournal of Urology, 2004
- LAPAROSCOPIC PYELOPLASTY WITH CONCOMITANT PYELOLITHOTOMYJournal of Urology, 2002
- Evaluation of Laparoscopic Retroperitoneal Surgery in Urinary Stone DiseaseJournal of Endourology, 2001
- Retroperitoneoscopic Pyelolithotomy via a Posterior Approach for Large Impacted Renal Pelvic StoneJournal of Endourology, 2001
- Laparoscopic versus Open UreterolithotomyEuropean Urology, 2001
- The Role of Laparoscopy in the Treatment of Renal and Ureteral CalculiJournal of Urology, 1997
- Value of Laparoscopy in the Management of Calculi Complicating Renal MalformationsJournal of Endourology, 1996
- Laparoscopic Pyelolithotomy for Calculus Removal in a Pelvic KidneyJournal of Urology, 1996
- Management of Hemorrhage After Percutaneous Renal SurgeryJournal of Urology, 1995