title: Laparoscopic pyeloplasty with concomitant pyelolithotomy: technique and outcomes.
abstract: OBJECTIVE
  Coexisting renal calculus disease may pose technical challenges in the surgical management of ureteropelvic junction obstruction. We report our experience with laparoscopic pyelolithotomy at the time of laparoscopic pyeloplasty and compare outcome data with a cohort of patients undergoing laparoscopic pyeloplasty without coexistent stone disease.
  
  
  METHODS
  We reviewed data on 117 patients undergoing laparoscopic pyeloplasty in the last 3 years at our institution. Fifteen (10.6%) patients underwent concomitant ipsilateral pyelolithotomy at the time of laparoscopic pyeloplasty. Laparoscopic graspers alone were used in 11 (73.3%) patients, flexible nephroscopy in 2 (13.3%) patients, and laparoscopic irrigation in 2 (13.3%) patients for renal stone removal. Patients in the group undergoing pyelolithotomy were compared with 15 matched patients undergoing laparoscopic pyeloplasty without concomitant calculus disease. Preoperative, intraoperative, and postoperative parameters were compared between the groups.
  
  
  RESULTS
  Overall stone-free rate after laparoscopic pyelolithotomy was 80%. Mean operative time was 174 minutes nu 170 minutes for the pyelolithotomy nu control group, respectively (P = 0.81).
  
  
  CONCLUSIONS
  Laparoscopic pyelolithotomy, primarily using laparoscopic graspers, is an efficient procedure with associated high stone-free rates without significant increase in operative time or morbidity. Intraoperative flexible nephroscopy may be necessary only occasionally for stone retrieval.
authors.affiliation: Department of Urology, Cleveland Clinic, Cleveland, Ohio 44195, USA. steinr@ccf.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Burak
authors.initials: B
authors.lastname: Turna
authors.forename: Mike M
authors.initials: MM
authors.lastname: Nguyen
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hafron
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
mesh_terms: D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011182:Postoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*