title: Management of pelvic stones larger than 20 mm: laparoscopic transperitoneal pyelolithotomy or percutaneous nephrolithotomy?
abstract: Large pelvic stones are frequently managed with percutaneous nephrolithotomy (PCNL) but laparoscopic transperitoneal pyelolithotomy (LTP) can be an alternative. We compared PCNL and LTP for the treatment of pelvic stones >20 mm in diameter.
  
  
  METHODS
  Between November 1999 and November 2004, 16 consecutive patients, mean age 42, with a single pelvic stone >20 x 10 mm (group I), underwent LTP as first-line treatment or after shockwave lithotripsy failure. They were compared with a similar population of 16 consecutive patients, mean age 45 (group II), who underwent PCNL for the same indication and were assessed retrospectively. We evaluated operative characteristics, complications, and results for each technique.
  
  
  RESULTS
  There was no difference between the two groups regarding the characteristics of patients and stones. Operative time duration was significantly longer in group I (129 vs. 75 min; p = 0.001) and conversion was required in 2 patients (12%). The main postoperative complications were urinary leakage (2 patients, 12%) in group I and bleeding (3 patients, 18%) in group II, but only 1 required blood transfusion. Mean hospital stay was respectively 6.5 and 5.6 days in groups I and II (p = 0.17). Stone-free rates were assessed at 3 months and were not different between group I and group II (88 vs. 82%).
  
  
  CONCLUSIONS
  The operative time of LTP is longer and the results of both techniques are comparable but postoperative morbidity is different. Specific indications of each technique must be determined although PCNL remains the gold standard for most large pelvic stones.
authors.affiliation: Department of Urology, St-Louis Hospital, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Meria
authors.forename: Stéphane
authors.initials: S
authors.lastname: Milcent
authors.forename: François
authors.initials: F
authors.lastname: Desgrandchamps
authors.forename: Pierre
authors.initials: P
authors.lastname: Mongiat-Artus
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Duclos
authors.forename: Pierre
authors.initials: P
authors.lastname: Teillac
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010529:Peritoneal Cavity / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome