title: Laparoscopic nephrectomy in xanthogranulomatous pyelonephritis: 7-year single-surgeon outcome.
abstract: OBJECTIVE
  To evaluate the outcome of laparoscopic nephrectomy in patients with xanthogranulomatous pyelonephritis (XGPN).
  
  
  METHODS
  The medical and procedural records of patients with pathologically confirmed XGPN from February 2004 to December 2010 were reviewed retrospectively. During this period, 19 patients (mean age 37.5 years, range 14-77) underwent surgical management of XGPN. The records of the clinical history, mode of presentation, surgical management, hospital stay, and complications were analyzed.
  
  
  RESULTS
  Laparoscopic nephrectomy was performed successfully in 14 patients (73.2%); 5 patients required conversion to open surgery. Of these 5 patients, 3 electively underwent conversion to open surgery because of nonprogression of the procedure, and in 2 patients, conversion was performed on an emergency basis because of bleeding from hilar vessels in 1 patient and diaphragmatic injury in the other. The operative time was 284 minutes (range 181-340), with a mean estimated blood loss of 220 mL (range 90-500) and mean analgesic (tramadol) requirement of 150 mg (range 50-500). Clavien grade I complications occurred in 2 patients, grade II in 3, and grade IIIa in 1 patient. Two patients had grade IVb complications. One patient required a blood transfusion. The mean hospital stay duration and the return to routine activities was 4.4 days (range 2-37) and 21 days (range 12-66), respectively.
  
  
  CONCLUSIONS
  Laparoscopic nephrectomy, although challenging, can be performed safely in most patients with XGPN. A greater conversion rate and longer operative time should be expected, and early conversion to an open approach might be required in difficult cases owing to a failure to proceed.
authors.affiliation: Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India. drnkarvind@gmail.com
authors.forename: Nand Kishore
authors.initials: NK
authors.lastname: Arvind
authors.forename: Onkar
authors.initials: O
authors.lastname: Singh
authors.forename: Qutub
authors.initials: Q
authors.lastname: Ali
authors.forename: Shilpi Singh
authors.initials: SS
authors.lastname: Gupta
authors.forename: Surbhi
authors.initials: S
authors.lastname: Sahay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007194:India; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D011705:Pyelonephritis, Xanthogranulomatous / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome