Laparoscopic surgery for renal stones: is it indicated in the modern endourology era?
OBJECTIVE
To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease.


METHODS
Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes.


RESULTS
Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214). Stone free status was 77% (10/13) and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters.


CONCLUSIONS
In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.
Nadu
Andrei
A
Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Israel. oscar.schatloff@gmail.com
Schatloff
Oscar
O
Morag
Roy
R
Ramon
Jacob
J
Winkler
Harry
H
D000293:Adolescent; D000328:Adult; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D014570:Urologic Diseases / Q000151:congenital / Q000601:surgery; D055815:Young Adult