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Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for a solitary renal pelvis stone larger than 3 cm: a prospective cohort study

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Abstract

To prospectively compare the outcome of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) in patients with a solitary renal pelvis stone larger than 30 mm. We analyzed demographic and perioperative parameters and intermediate outcome in 30 adults who underwent transperitoneal LP for solitary renal pelvis stone larger than 30 mm (Group I) and compared the results with 30 patients who underwent PCNL (Group II). The two groups were matched for age, sex and stone size (Group I 35.3 ± 7.33 mm, Group II 36.6 ± 7.0 mm; P = 0.47). Mean operative time was significantly longer in LP group (120.5 ± 39.94 min versus 98.1 ± 23.28 min; P = 0.01, 95 % CI 5.43–39.23). Stone-free rate after LP was significantly higher than after PCNL (100 % versus 76.7 %; P = 0.01). On the discharge day, no residual stone was found in LP group, and significant residual stone (mean size 9.8 mm, range 7–15 mm) was found in seven patients (23.3 %) in PCNL group. After the ancillary procedures, the stone-free rates were 100 % in LP and 96.6 % in PCNL group at the end of follow-up. The average overall treatment cost was significantly lower in LP (683.9 USD versus 815.9 USD; P < 0.001). Mean postoperative decreases in hemoglobin was similar in both groups. Given adequate laparoscopic experience, for patients with a solitary renal pelvis stone larger than 3 cm, LP can be considered as an appropriate second choice to PCNL. It can be a potentially cost-effective treatment option in terms of one-session stone-free rate and postoperative complications. However, the potential benefits of LP need to be weighed against the more invasive nature of this procedure.

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Acknowledgments

This work was supported by Shiraz University of Medical Sciences. This report is based on research done in partial fulfillment of the requirements for the specialty degree in urology (Dissertation no. 89-01-01-2391) awarded to Dr. Khakbaz. We thank K. Shashok (Author AID in the Eastern Mediterranean) for improving the use of English in the manuscript.

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran

    Alireza Aminsharifi, Mohammad-Mehdi Hosseini & Abbasali Khakbaz

  2. Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Alireza Aminsharifi

  3. Shaheed Faghihi Hospital, P.O. Box 71344, Zand Street, Shiraz, Iran

    Alireza Aminsharifi

Authors
  1. Alireza Aminsharifi
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  2. Mohammad-Mehdi Hosseini
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  3. Abbasali Khakbaz
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Correspondence to Alireza Aminsharifi.

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Aminsharifi, A., Hosseini, MM. & Khakbaz, A. Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for a solitary renal pelvis stone larger than 3 cm: a prospective cohort study. Urolithiasis 41, 493–497 (2013). https://doi.org/10.1007/s00240-013-0589-0

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  • DOI: https://doi.org/10.1007/s00240-013-0589-0

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