Laparoscopic pyeloplasty with concomitant pyelolithotomy--is it an effective mode of treatment?
BACKGROUND
Pelviureteric junction (PUJ) obstruction and concomitant renal calculus disease may coexist. We present our experience with simultaneous laparoscopic pyeloplasty and pyelolithotomy in such patients.


METHODS
20 patients (20 renal units) underwent transperitoneal laparoscopic pyeloplasty and concomitant pyelolithotomy at our institution. An initial dismembering of the PUJ followed by removal of the calculi with rigid or semi-rigid graspers were done. Calyceal stones were removed with the aid of a flexible cystoscope, rigid/flexible ureteroscope and simultaneous fluoroscopy. The pyeloplasty was subsequently performed in all cases.


RESULTS
A median of 2 stones (range 1-12) were recovered from the 20 renal units. Complete stone clearance was possible in 15/20 patients (75%). Three patients underwent subsequent extracorporeal shock-wave lithotripsy and 2 required percutaneous nephrolithotomy. All patients were rendered stone-free at 6 months' follow-up. Diuretic renography at follow-up revealed improved drainage in 18/20 (90%) patients; 2 patients had an equivocal drainage pattern but their symptoms disappeared.


CONCLUSIONS
Laparoscopic pyeloplasty with concomitant pyeloplasty is feasible and effective, however patients must be counseled about the possibilities of ancillary procedures to achieve complete stone clearance.
Srivastava
Aneesh
A
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. anees@sgpgi.ac.in
Singh
Pratipal
P
Gupta
Manu
M
Ansari
M S
MS
Mandhani
Anil
A
Kapoor
Rakesh
R
Kumar
Anant
A
Dubey
Deepak
D
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*