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Urolithiasis (2013) 41:493497 DOI 10.1007/s00240-013-0589-0
ORIGINAL PAPER
Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for a solitary renal pelvis stone larger than 3 cm: a prospective cohort study
Alireza Aminshari Mohammad-Mehdi Hosseini
Abbasali Khakbaz
Received: 1 April 2013 / Accepted: 9 July 2013 / Published online: 23 July 2013 Springer-Verlag Berlin Heidelberg 2013
Abstract To prospectively compare the outcome of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) in patients with a solitary renal pelvis stone larger than 30 mm. We analyzed demographic and perioperative parameters and intermediate outcome in 30 adults who underwent transperitoneal LP for solitary renal pelvis stone larger than 30 mm (Group I) and compared the results with 30 patients who underwent PCNL (Group II). The two groups were matched for age, sex and stone size (Group I 35.3 7.33 mm, Group II 36.6 7.0 mm; P = 0.47). Mean operative time was signicantly longer in LP group (120.5 39.94 min versus 98.1 23.28 min; P = 0.01, 95 % CI 5.4339.23). Stone-free rate after LP was signicantly higher than after PCNL (100 % versus76.7 %; P = 0.01). On the discharge day, no residual stone was found in LP group, and signicant residual stone (mean size 9.8 mm, range 715 mm) was found in seven patients (23.3 %) in PCNL group. After the ancillary procedures, the stone-free rates were 100 % in LP and 96.6 % in PCNL group at the end of follow-up. The average overall treatment cost was signicantly lower in LP (683.9 USD versus 815.9 USD; P \ 0.001). Mean postoperative decreases in hemoglobin was similar in both groups. Given
adequate laparoscopic experience, for patients with a solitary renal pelvis stone larger than 3 cm, LP can be considered as an appropriate second choice to PCNL. It can be a potentially cost-effective treatment option in terms of one-session stone-free rate and postoperative complications. However, the potential benets of LP need to be weighed against the more invasive nature of this procedure.
Keywords Laparoscopy Pyelolithotomy
Laparoscopic pyelolithotomy Percutaneous
nephrolithotomy Renal stone
Introduction
During the previous two decades, with the popularization of percutaneous nephrolithotomy (PCNL), the management of large kidney stones has been revolutionized [1]. In centers with adequate experience in minimally invasive surgery, the need for open stone surgery (OSS)...