Laparoscopic Pyelolithotomy: Initial Experience with 62 Patients

Objective: To evaluate the role of the laparoscopic approach in the management of pelvic calculi in a urology centre in Douala, Cameroon. Materials and Methods: This was a retrospective study carried out from 2014 to 2019 involving 62 patients with calculi at the renal pelvis managed through laparoscopic pyelolithotomy. Results: We recruited 62 patients (38 men and 24 women) with a median age of 36 [25 - 48] years. Nephritic colic was the most frequently encountered presenting complaint (92% of cases). In 56.45% of cases, the stone was on the left side of the body. Twelve patients had kidney acute failure at the time of diagnosis. Five patients received antibiotics for urinary tract infections before the operation. Before surgery, eight double J stents were placed in 8 patients;in five because of urinary tract infection and in three because of nephritic colic. In all the cases, the definitive diagnosis was made using abdominal CT scans. The median size of the calculi was 22 [17 - 28] mm. Dilatation of the pyelocaliceal cavity was noticed in all the patients. The median surgery duration was 100 [90 - 120] minutes. Drainage of the urinary tract using a double J stent was performed in all the patients, whereas percutaneous drainage was performed only in 9.67% of cases. There was no case of conversion to open surgery. Control ultrasound performed one month after the removal of the double J stent did not reveal any residual stones in the pyelocaliceal cavities. Conclusion: Laparoscopic pyelolithotomy is a mini-invasive technique that is adequate for the management of voluminous pelvic calculi.

Comparison of the postoperative trauma of the retroperitoneal laparoscopic intrasinusal pyelolithotomy and percutaneous nephrolithotomy

Objective: To study the postoperative trauma of the retroperitoneal laparoscopic intrasinusal pyelolithotomy (RLIP) and percutaneous nephrolithotomy (PCNL). Methods: A total of 118 patients who were diagnosed with single pelvis calculus in Shanghai Punan Hospital of Pudong New District between September 2013 and February 2017 were selected and randomly divided into RLIP group and PCNL group who received retroperitoneal laparoscopic intrasinusal pyelolithotomy and percutaneous nephrolithotomy respectively. The removal of the stones was observed 1 week and 4 weeks after surgery, and 3mL of cubital venous blood was collected 3 d and 7 d after operation to detect the renal function indicators, inflammatory markers and stress indicators. Results: The stone removal success rate of RLIP group 1 week and 4 weeks after operation were significantly higher than those of PCNL group, serum BUN, Scr and Cys-C contents as well as eGFR levels were not significantly different between RLIP group and PCNL group 3 d and 7 d after operation, and serum Cor, NE, HSP70, NO, IL-6, hs-CRP, TNF-α and PGE2 contents of RLIP group 3 d and 7 d after operation were significantly lower than those of PCNL group. Conclusion: RLIP is significantly better than PCNL in stone removal and causes significantly less postoperative trauma than PCNL.