Laparoscopic pyelolithotomy and its role in modern surgery of nephrolithiasis


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Aim. To determine the place of laparoscopic pyelolithotomy in surgical management of nephrolithiasis. Materials and Methods. We analyzed 16 laparoscopic pyelolithotomies performed in our clinic over the last few years for large and stag-horn stones of anomalous kidneys (n=8), the "giant" (>30-40 cc) monolithic stones of the large extrarenal pelvis (n=3), multiple stones of PCS with the stone burden of ≥ 40 cm3 (n=2) and large recurrent (after PCNL) kidney stones in patients at risk of bacteriotoxic complications of percutaneous nephroscopy (n=3). The age of the patients ranged from 39 to 72 years (mean age 51±8 years). The average density of stones was 1012 (160-1483) HU. Results. There were no conversions to open surgery. The mean operating time of laparoscopic pyelolithotomy was 137 (96-255) minutes, flexible transabdominal pyelocalycoscopy 31.2 (12-110) min. The stone-free rate was 87%. Residual clinically insignificant stones were found in two (13%) patients with staghorn horseshoe kidney calculi and complex PCS. The preoperative hospital stay was 1 day, postoperative-from 2 to 18 (mean 6) days. Discussion. We believe that laparoscopic pyelolithotomy supplemented by transabdominal flexible pyelocalycoscopy may be recommended for surgical management of patients with "giant", multiple and infected kidney stones, because the length of their percutaneous removal is beyond the recommended time intervals and it is accompanied by an increased risk of septic complications.

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作者简介

P. Glybochko

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: rektorat@mma.ru
Academician of the RAS, Dr.Med.Sci., Prof., Rector; Director of Research Institute for Uronephrology and Human Reproductive Health

Yu. Alyaev

I.M. Sechenov First MSMU of Minzdrav of Russia

Email: ugalyaev@mail.ru
Corr. -Member of the RAS, Dr.Med.Sci., Prof., Head of Department of Urology; Director of the Urology Clinic

L. Rapoport

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: leonidrapoport@yandex.ru
Dr.Med.Sci., Professor at the Department of Urology; Deputy Director for Clinical Care of the Research Institute for Uronephrology and Human Reproductive Health

M. Enikeev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: enikmic@mail.ru
Dr.Med.Sci., Head of the 2nd Department of the Urology Clinic, Professor at the Department of Urology

D. Tsarichenko

I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia (Sechenov University)

Email: tsarichenkodg@yandex.ru
Ph.D., M.D., Professor at the Department of Urology

E. Shpot

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: shpot@inbox.ru
Ph.D., Associate Professor at the Department of Urology

D. Korolev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: demix84@inbox.ru
Urologist, Ph.D. Student at the Research Institute for Uronephrology and Human Reproductive Health

A. Vorobyev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Urologist, Ph.D. Student at the Urology Clinic

D. Enikeev

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: enikeev_dv@mail.ru
Deputy Director for Science, Research Institute of Uronephrology and Human Reproductive Health

参考

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