Laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones

• Published in: Urolithiasis 2024-01, Vol.52 (1), p.22, Article 22
• Main Authors: Hu, Liyong, Zhang, Nianzhao, Zhang, Xiaoyi, Liang, Hao, Fan, Yidong, Chen, Jun
• Format: Article
• Language: English
• Subjects: Humans; Kidney Calculi - surgery; Laparoscopy; Lithotripsy; Lithotripsy - adverse effects; Medical Biochemistry; Medicine; Medicine & Public Health; Nephrology; Nephrotomy; Patients; Retrospective Studies; Urology
• ISSN: 2194-7236; 2194-7228; 2194-7236
• DOI: 10.1007/s00240-023-01522-7

The purpose of the study was to introduce a novel surgical approach of combining laparoscopic pyelotomy with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones. Between May 2021 and April 2023, 32 patients underwent laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope and their perioperative variables were retrospectively collected and outcomes were assessed. Dissection and incision of the anterior renal pelvis wall was performed via a laparoscope. A 19.5 F nephroscope was introduced into the renal pelvis through a laparoscopic trocar from the incision. Stones were fragmented and sucked out using a 3.3 mm ultrasonic probe placed through the nephroscope. All operations were completed successfully and the stone-free rate at 3 days after operation was 87.5% (28/32). Four (12.5%, 4/32) patients with staghorn stones had a small residual stone in the lower calyx after operation and did not require reintervention. No patient required perioperative transfusion and four (12.5%, 4/32) patients with struvite stones developed postoperative fever, which was successfully treated with intravenous antibiotics. The mean follow-up time was 14.0 ± 7.2 months, with no patient developing long-term complications. This approach offers a safe and effective treatment option for complex renal stones, as the method exhibits a high clearance rate with few complications.