Management of Migrated or Residual Stones Following Laparoscopic Pyelolithotomy and Ureterolithotomy in Abnormal Kidneys: A Prospective and Randomized Comparison

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

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Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060520983136 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098313

Author(s):

Tie Mao ◽

Na Wei ◽

Jing Yu ◽

Yinghui Lu

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Percutaneous Nephrolithotomy ◽

Meta Analysis ◽

Renal Stones ◽

Efficacy And Safety ◽

Complementary Treatment ◽

Laparoscopic Pyelolithotomy ◽

Stone Free Rate ◽

Free Rate

Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

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Choice of the method of draining the urinary tract in residual stones after percutaneous nephrolithomy in children

European Urology Supplements ◽

10.1016/s1569-9056(19)35042-0 ◽

2019 ◽

Vol 18 (12) ◽

pp. e3637

Author(s):

Y.S. Nadjimitdinov ◽

Sh.T. Mukhtarov ◽

Sh.Abbosov Sh

Keyword(s):

Urinary Tract ◽

Residual Stones

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Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients

Arab Journal of Urology ◽

10.1016/j.aju.2014.10.004 ◽

2015 ◽

Vol 13 (2) ◽

pp. 139-145 ◽

Cited By ~ 7

Author(s):

Himesh Ramesh Gandhi ◽

Appu Thomas ◽

Balagopal Nair ◽

Ginilkumar Pooleri

Keyword(s):

High Risk ◽

High Risk Patients ◽

Laparoscopic Pyelolithotomy ◽

Risk Patients

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Carbon Dioxide Based Nephroscopy: A Trick for Laparoscopic Pyelolithotomy

Journal of Endourology ◽

10.1089/end.2008.0325 ◽

2008 ◽

Vol 22 (12) ◽

pp. 2661-2664 ◽

Cited By ~ 5

Author(s):

Barry Michael Mason ◽

David Hoenig

Keyword(s):

Carbon Dioxide ◽

Laparoscopic Pyelolithotomy

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Complex cystine kidney stones treated with combined robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy

Urologia Journal ◽

10.5301/uro.5000215 ◽

2017 ◽

Vol 85 (2) ◽

pp. 76-78 ◽

Cited By ~ 2

Author(s):

Luca Meggiato ◽

Francesco Cattaneo ◽

Fabio Zattoni ◽

Fabrizio Dal Moro ◽

Paolo Beltrami ◽

...

Keyword(s):

Kidney Stones ◽

Renal Stones ◽

Renal Calculi ◽

Robot Assisted ◽

Intraoperative Bleeding ◽

Laparoscopic Pyelolithotomy ◽

Urinary Infections ◽

Hospital Referral ◽

Combined Technique ◽

Rare Autosomal Recessive Disease

Introduction: Cystinuria, a rare autosomal recessive disease characterized by a defect in cystine renal reabsorption, can often determine complex cystine renal calculi, leading to important complications such as urinary obstruction, urinary infections, and impaired kidney function. Complex kidney stones can have a difficult management and can be very arduous to treat. Case description: We present the case of a 20-year-old Jeowah’s witness woman with complex cystine renal stones treated with combined robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy. Conclusions: The combination of robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy can be useful to achieve an immediate high stone clearance rate also in complex renal stones. This combined technique could be indicated to minimize intraoperative bleeding. Moreover, it can also be used in pediatric cases or when there is no ureteral compliance. However, this strategy can be performed only in hospital referral centers by expert surgeons.

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Comparison between different techniques for management of renal stones in horseshoe kidneys

QJM ◽

10.1093/qjmed/hcab110.001 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Abdel Fattah Mohammed Aggour ◽

Mohamed Kotb Ahmed Tolba ◽

Abdelrahman nazmy abbas hatata

Keyword(s):

Horseshoe Kidney ◽

Renal Stones ◽

Operative Management ◽

Flexible Ureteroscopy ◽

Stone Clearance ◽

Stone Burden ◽

Laparoscopic Pyelolithotomy ◽

Almost All ◽

Laparoscopic Assisted ◽

Operating Surgeon

Abstract Objective To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys. Materials and Methods We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. Results In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only.. Conclusions Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

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