Laparoscopic pyeloplasty with concomitant pyelolithotomy: technique and outcomes.
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. 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. 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). 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.