Laparoscopic pyeloplasty with concomitant pyelolithotomy--is it an effective mode of treatment?

Urol Int. 2008;80(3):306-9. doi: 10.1159/000127347. Epub 2008 May 14.

Abstract

Introduction: Pelviureteric junction (PUJ) obstruction and concomitant renal calculus disease may coexist. We present our experience with simultaneous laparoscopic pyeloplasty and pyelolithotomy in such patients.

Method: 20 patients (20 renal units) underwent transperitoneal laparoscopic pyeloplasty and concomitant pyelolithotomy at our institution. An initial dismembering of the PUJ followed by removal of the calculi with rigid or semi-rigid graspers were done. Calyceal stones were removed with the aid of a flexible cystoscope, rigid/flexible ureteroscope and simultaneous fluoroscopy. The pyeloplasty was subsequently performed in all cases.

Result: A median of 2 stones (range 1-12) were recovered from the 20 renal units. Complete stone clearance was possible in 15/20 patients (75%). Three patients underwent subsequent extracorporeal shock-wave lithotripsy and 2 required percutaneous nephrolithotomy. All patients were rendered stone-free at 6 months' follow-up. Diuretic renography at follow-up revealed improved drainage in 18/20 (90%) patients; 2 patients had an equivocal drainage pattern but their symptoms disappeared.

Conclusion: Laparoscopic pyeloplasty with concomitant pyeloplasty is feasible and effective, however patients must be counseled about the possibilities of ancillary procedures to achieve complete stone clearance.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Female
  • Humans
  • Kidney Calculi / complications
  • Kidney Calculi / surgery*
  • Kidney Pelvis / surgery*
  • Laparoscopy*
  • Male
  • Middle Aged
  • Prospective Studies
  • Treatment Outcome
  • Ureteral Obstruction / complications
  • Ureteral Obstruction / surgery*