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Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
419
Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study Eur Urol Suppl 2017; 16(3);e741
Fawzi A.M., Sakr A., Eliwa A., Omran M., Youssef M., Desoky E., Seleem M. Zagazig University, Dept. of Urology, Zagazig, Egypt INTRODUCTION & OBJECTIVES: Urolithiasis is the most common complication in horseshoe kidney. Treatment of stones in horseshoe kidneys encompasses a wide variety of options. The aim of this study is to compare between transperitoneal laparoscopic pyelolithotomy (TPLP) and retrograde intrarenal surgery (RIRS) for treatment of renal pelvis stones in horseshoe kidneys regarding several perioperative parameters. MATERIAL & METHODS: Between February 2011 and December 2014, eighteen patients with renal pelvis stones more than 2 cm in horseshoe kidney were systematically randomized into two groups; Group A included 9 patients treated by TPLP and group B included 9 patients treated by RIRS with holmium laser lithotripsy. Patients with uncorrectable coagulopathy, morbid obesity, prior abdominal surgery and ureteropelvic junction obstruction were excluded from the study. Preoperative evaluation included history taking, physical examination, laboratory investigations (Urinalysis, urine culture/sensitivity in cases with pyuria, complete blood count, kidney function tests, liver function tests, coagulation profile and random blood sugar) and radiological investigations (KUB, pelvi-abdominal ultrasonography and non-contrast spiral CT). Both groups were compared regarding peri-operative data. RESULTS: There was no significant difference between both groups regarding patients' demographics and stone characteristics. Mean age was 43.6±10.2 and 44.2±12.3 years for groups A and B respectively (p=0.91). Mean stone diameter was 3.2±0.6 and 2.9±0.4 cm for groups A and B respectively (p=0.23). Mean operative time was significantly higher in the TPLP group than in the RIRS group (135.7±37.1 vs 82.4±15.6 minutes, p=0.001). Mean fluoroscopy time was 16.2±3.4 seconds in group B while no fluoroscopy was used in group A.Mean drop in hemoglobin level was 1.3±0.26 g/dl for group A and 0.34±0.1 g/dl for group B (p<0.0001). One-session stone free rate was 100% and 66.6% for groups A and B respectively (p=0.2). No major intraoperative complications were encountered in both groups. One case in group A suffered postoperative high grade fever. Persistent urinary leakage occurred in one case in group A. Mean hospital stay was 4.2±1.2 and 1.4±0.4 days for groups A and B respectively (p< 0.0001). CONCLUSIONS: TPLP is an effective approach for management of patients with pelvic stones in horseshoe kidneys with higher stone-free rates however RIRS has the merits of less invasiveness, shorter operative time and lower complication rates.
Eur Urol Suppl 2017; 16(3);e741 Powered by TCPDF (www.tcpdf.org)
419
Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study Eur Urol Suppl 2017; 16(3);e741
Fawzi A.M., Sakr A., Eliwa A., Omran M., Youssef M., Desoky E., Seleem M. Zagazig University, Dept. of Urology, Zagazig, Egypt INTRODUCTION & OBJECTIVES: Urolithiasis is the most common complication in horseshoe kidney. Treatment of stones in horseshoe kidneys encompasses a wide variety of options. The aim of this study is to compare between transperitoneal laparoscopic pyelolithotomy (TPLP) and retrograde intrarenal surgery (RIRS) for treatment of renal pelvis stones in horseshoe kidneys regarding several perioperative parameters. MATERIAL & METHODS: Between February 2011 and December 2014, eighteen patients with renal pelvis stones more than 2 cm in horseshoe kidney were systematically randomized into two groups; Group A included 9 patients treated by TPLP and group B included 9 patients treated by RIRS with holmium laser lithotripsy. Patients with uncorrectable coagulopathy, morbid obesity, prior abdominal surgery and ureteropelvic junction obstruction were excluded from the study. Preoperative evaluation included history taking, physical examination, laboratory investigations (Urinalysis, urine culture/sensitivity in cases with pyuria, complete blood count, kidney function tests, liver function tests, coagulation profile and random blood sugar) and radiological investigations (KUB, pelvi-abdominal ultrasonography and non-contrast spiral CT). Both groups were compared regarding peri-operative data. RESULTS: There was no significant difference between both groups regarding patients' demographics and stone characteristics. Mean age was 43.6±10.2 and 44.2±12.3 years for groups A and B respectively (p=0.91). Mean stone diameter was 3.2±0.6 and 2.9±0.4 cm for groups A and B respectively (p=0.23). Mean operative time was significantly higher in the TPLP group than in the RIRS group (135.7±37.1 vs 82.4±15.6 minutes, p=0.001). Mean fluoroscopy time was 16.2±3.4 seconds in group B while no fluoroscopy was used in group A.Mean drop in hemoglobin level was 1.3±0.26 g/dl for group A and 0.34±0.1 g/dl for group B (p<0.0001). One-session stone free rate was 100% and 66.6% for groups A and B respectively (p=0.2). No major intraoperative complications were encountered in both groups. One case in group A suffered postoperative high grade fever. Persistent urinary leakage occurred in one case in group A. Mean hospital stay was 4.2±1.2 and 1.4±0.4 days for groups A and B respectively (p< 0.0001). CONCLUSIONS: TPLP is an effective approach for management of patients with pelvic stones in horseshoe kidneys with higher stone-free rates however RIRS has the merits of less invasiveness, shorter operative time and lower complication rates.
Eur Urol Suppl 2017; 16(3);e741 Powered by TCPDF (www.tcpdf.org)