Retroperitoneal Laparoscopic Pyelolithotomy for Unilateral Large Sized Staghorn Renal Calculi

Abstract

Background: The introduction of endourological procedures such as percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy have led to a revolution in the management of nephrolithiasis. But in large sized staghorn calculi with branching, laparoscopic pyelolithotomy has a role and in recent years, retroperitoneal laparoscopic pyelolithotomy (RPPL) approach has been reported as a feasible alternative in various series. Aims and Objectives: To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy (RPPL) in management of renal calculi bigger than 4 cm. Methods: This prospective study was conducted from January 2017 to June 2020 at the Department of Surgery, SKIMS Medical College, Bemina, Srinagar, Kashmir, India. The study included a total of 20 cases with the diagnosis of solitary renal pelvic calculi sized 4 cm and above. Results: There were 16 males and 4 females. The mean operative time was 107 min (range 86min-124 min) and the approximate mean blood loss was above 98.2 ml (range 74 ml – 144ml). Stone clearance was achieved in 18 cases and 2 cases were converted to the open procedure due to technical difficulties. Conclusion: Retroperitoneal laparoscopic pyelolithotomy (RPPL) is a safe, simple and feasible option that can be recommended for management of large sized staghorn renal calculi, if proper logistics and skilled personnel are available.

Keywords

• retroperitoneal laparoscopic pyelolithotomy
• renal calculi
• nephrolithiasis
• percutaneous nephrolithotripsy
• extra corporeal shock wave lithotripsy