Skip to main content
Top
Published in: World Journal of Urology 7/2019

01-07-2019 | Original Article

Perioperative and long-term results of retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for staghorn calculi: a single-center randomized controlled trial

Authors: Ya Xiao, Qianwei Li, Chibing Huang, Pingxian Wang, Jiaxi Zhang, Weihua Fu

Published in: World Journal of Urology | Issue 7/2019

Login to get access

Abstract

Purpose

To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi.

Methods

From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups.

Results

Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months.

Conclusions

PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.
Literature
2.
go back to reference Pradère B, Doizi S, Proietti S et al (2018) Evaluation of guidelines for surgical management of urolithiasis. J Urol 199(5):1267–1271CrossRef Pradère B, Doizi S, Proietti S et al (2018) Evaluation of guidelines for surgical management of urolithiasis. J Urol 199(5):1267–1271CrossRef
4.
go back to reference Kyriazis I, Panagopoulos V, Kallidonis P et al (2015) Complications in percutaneous nephrolithotomy. World J Urol 33(8):1069–1077CrossRef Kyriazis I, Panagopoulos V, Kallidonis P et al (2015) Complications in percutaneous nephrolithotomy. World J Urol 33(8):1069–1077CrossRef
5.
go back to reference Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51(4):899–906CrossRef Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51(4):899–906CrossRef
6.
go back to reference Simforoosh N, Aminsharifi A (2013) Laparoscopic management in stone disease. Curr Opin Urol 23(2):169–174CrossRef Simforoosh N, Aminsharifi A (2013) Laparoscopic management in stone disease. Curr Opin Urol 23(2):169–174CrossRef
7.
go back to reference Wang X, Li S, Liu T et al (2013) Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis. J Urol 190(3):888–893CrossRef Wang X, Li S, Liu T et al (2013) Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis. J Urol 190(3):888–893CrossRef
8.
go back to reference Wang J, Yang Y, Chen M et al (2016) Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter > 2 cm): a meta-analysis. Acta Chir Belg 116(6):346–356CrossRef Wang J, Yang Y, Chen M et al (2016) Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter > 2 cm): a meta-analysis. Acta Chir Belg 116(6):346–356CrossRef
9.
go back to reference Gaur DD, Trivedi S, Prabhudesai MR et al (2002) Retroperitoneal laparoscopic pyelolithotomy for staghorn stones. J Laparoendosc Adv Surg Tech A 12(4):299–303CrossRef Gaur DD, Trivedi S, Prabhudesai MR et al (2002) Retroperitoneal laparoscopic pyelolithotomy for staghorn stones. J Laparoendosc Adv Surg Tech A 12(4):299–303CrossRef
10.
go back to reference Nambirajan T, Jeschke S, Albqami N et al (2005) Role of laparoscopy in management of renal stones: single-center experience and review of literature. J Endourol 19(3):353–359CrossRef Nambirajan T, Jeschke S, Albqami N et al (2005) Role of laparoscopy in management of renal stones: single-center experience and review of literature. J Endourol 19(3):353–359CrossRef
11.
go back to reference Kochkin AD, Gallyamov EA, Medvedev VL et al (2017) Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study. Urologiia 3:40–45CrossRef Kochkin AD, Gallyamov EA, Medvedev VL et al (2017) Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study. Urologiia 3:40–45CrossRef
12.
go back to reference El-Nahas AR, Eraky I, Shokeir AA et al (2012) Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone. Urology 79(6):1236–1241CrossRef El-Nahas AR, Eraky I, Shokeir AA et al (2012) Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone. Urology 79(6):1236–1241CrossRef
13.
go back to reference Lei M, Zhu W, Wan SP et al (2014) The outcome of urine culture positive and culture negative staghorn calculi after minimally invasive percutaneous nephrolithotomy. Urolithiasis 42(3):235–240CrossRef Lei M, Zhu W, Wan SP et al (2014) The outcome of urine culture positive and culture negative staghorn calculi after minimally invasive percutaneous nephrolithotomy. Urolithiasis 42(3):235–240CrossRef
14.
go back to reference Lee JK, Kim BS, Park YK (2013) Predictive factors for bleeding during percutaneous nephrolithotomy. Korean J Urol 54(7):448–453CrossRef Lee JK, Kim BS, Park YK (2013) Predictive factors for bleeding during percutaneous nephrolithotomy. Korean J Urol 54(7):448–453CrossRef
15.
go back to reference El-Nahas AR, Shokeir AA, El-Assmy AM et al (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 177(2):576–579CrossRef El-Nahas AR, Shokeir AA, El-Assmy AM et al (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 177(2):576–579CrossRef
16.
go back to reference Kreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10(10):598–605CrossRef Kreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10(10):598–605CrossRef
17.
go back to reference Korets R, Graversen JA, Kates M et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186(5):1899–1903CrossRef Korets R, Graversen JA, Kates M et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186(5):1899–1903CrossRef
18.
go back to reference Gutierrez J, Smith A, Geavlete P et al (2013) Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 31(5):1135–1140CrossRef Gutierrez J, Smith A, Geavlete P et al (2013) Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 31(5):1135–1140CrossRef
19.
go back to reference El-Nahas AR, Eraky I, Shokeir AA et al (2011) Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones. BJU Int 108(5):750–754 El-Nahas AR, Eraky I, Shokeir AA et al (2011) Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones. BJU Int 108(5):750–754
20.
go back to reference Akman T, Binbay M, Kezer C et al (2012) Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi: outcomes of a long-term followup. J Urol 187(5):1656–1661CrossRef Akman T, Binbay M, Kezer C et al (2012) Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi: outcomes of a long-term followup. J Urol 187(5):1656–1661CrossRef
21.
go back to reference Teichman JM, Long RD, Hulbert JC (1995) Long-term renal fate and prognosis after staghorn calculus management. J Urol 153(5):1403–1407CrossRef Teichman JM, Long RD, Hulbert JC (1995) Long-term renal fate and prognosis after staghorn calculus management. J Urol 153(5):1403–1407CrossRef
22.
go back to reference Basiri A, Tabibi A, Nouralizadeh A et al (2014) Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial. Urol J 11(6):1932–1937PubMed Basiri A, Tabibi A, Nouralizadeh A et al (2014) Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial. Urol J 11(6):1932–1937PubMed
Metadata
Title
Perioperative and long-term results of retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for staghorn calculi: a single-center randomized controlled trial
Authors
Ya Xiao
Qianwei Li
Chibing Huang
Pingxian Wang
Jiaxi Zhang
Weihua Fu
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 7/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-018-2526-x

Other articles of this Issue 7/2019

World Journal of Urology 7/2019 Go to the issue