title: Laparoscopic versus open radical nephrectomy for xanthogranulomatous pyelonephritis: Contemporary outcomes analysis.
abstract: OBJECTIVE
  Early experience with laparoscopic nephrectomy for xanthogranulomatous pyelonephritis (XGP) was associated with high conversion and complication rates. We describe our institution's experience with this procedure compared with a contemporary cohort of patients with XGP treated by open nephrectomy.
  
  
  METHODS
  Retrospective review of surgical pathology reports from radical nephrectomies at our institution between 1995 and 2005 yielded a diagnosis of XGP in 12 patients, 6 of whom had undergone laparoscopic surgery. Each patient's medical records were reviewed, with intraoperative and postoperative parameters, including complications, being recorded.
  
  
  RESULTS
  Transperitoneal laparoscopic nephrectomy was successful in five patients (83%). Hand-assist ports were utilized in two patients because of failure to progress. The operative times were 301 +/- 106 minutes and 167 +/- 40 minutes in the laparoscopic and open-surgery groups, respectively (P = 0.03). There was no statistical difference with regard to estimated blood loss, transfusion rate, or parenteral analgesic requirements, but there was a trend toward a shorter stay for the laparoscopic group. Complications were noted in three and two patients in the laparoscopic and open-surgery groups, respectively.
  
  
  CONCLUSIONS
  The outcomes of nephrectomy for XGP were similar regardless of surgical approach. The results in patients with XGP were similar to initial reports in the literature and may be dependent on surgeon experience. We believe that in experienced hands, laparoscopic nephrectomy may be offered to patients with XGP.
authors.affiliation: Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Vanderbrink
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ost
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Rastinehad
authors.forename: Ann
authors.initials: A
authors.lastname: Anderson
authors.forename: Gopal H
authors.initials: GH
authors.lastname: Badlani
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Smith
authors.forename: Michael A
authors.initials: MA
authors.lastname: Levine
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011182:Postoperative Care; D011705:Pyelonephritis, Xanthogranulomatous / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome