title: Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature.
abstract: BACKGROUND
  Approximately one out of five patients with ureteropelvic junction obstruction (UPJO) present lithiasis in the same setting. We present our outcomes of simultaneous laparoscopic management of UPJO and pelvic or calyceal lithiasis and review the current literature.
  
  
  METHODS
  Thirteen patients, with a mean age of 42.8±13.3 years were diagnosed with UPJO and pelvic or calyceal lithiasis. All patients were subjected to laparoscopic dismembered Hynes-Anderson pyeloplasty along with removal of single or multiple stones, using a combination of laparoscopic graspers, irrigation, and flexible nephroscopy with nitinol baskets.
  
  
  RESULTS
  The mean operative time was 218.8±66 minutes. In two cases, transposition of the ureter due to crossing vessels was performed. The mean diameter of the largest stone was 0.87±0.25 cm and the mean number of stones retrieved was 8.2 (1-32). Eleven out of 13 patients (84.6%) were rendered stone-free. Complications included prolonged urine output from the drain in one case (Clavien grade I) and urinoma formation requiring drainage in another case (Clavien grade IIIa). The mean postoperative follow-up was 30.2 (7-51) months. No patient has experienced stone or UPJO recurrence.
  
  
  CONCLUSIONS
  Laparoscopy for the management of UPJO along with renal stone removal seems a very appealing treatment, with all the advantages of minimally invasive surgery. Concomitant renal stones do not affect the outcome of laparoscopic pyeloplasty, at least in the midterm. According to our results and the latest literature data, we advocate laparoscopic management as the treatment of choice for these cases.
authors.affiliation: Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Stravodimos
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stilianos
authors.initials: S
authors.lastname: Giannakopoulos
authors.affiliation: Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Tyritzis
authors.affiliation: Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Aristeides
authors.initials: A
authors.lastname: Alevizopoulos
authors.affiliation: Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Papadoukakis
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Touloupidis
authors.affiliation: Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Constantinides
keywords: laparoscopic pyeloplasty; lithiasis; ureteropelvic junction obstruction