To Evaluate Role of Retroperitoneal Laparoscopic Pyelolithotomy in Management of Staghorn Renal Stones

Jagdish Chander, Nikhil Gupta, Dr, Pawanindra Lal, Professor, Vinod K Ramteke, Professor

Maulana Azad Medical College, Delhi, India

Introduction: Staghorn renal stones are associated with high risk of recurrence so complete removal is essential which is sometimes difficult to achieve with ESWL, PCNL or a combination of these. This study is an endeavour to evaluate the role of retroperitoneoscopic pyelolithotomy (RPPL) in the management of such stones.

Materials and Methods: The study was conducted at Maulana Azad Medical College, Delhi. The study included 34 cases presenting to the surgical OPD with features of staghorn calculi on intravenous pyelography. RPPL was performed in all the patients; 3 required holmium laser for fragmentation of stone. Image guided nephrolithotomy was carried out in 2 cases for left over fragments.

Results: Stone Clearance rate in the present study was 94.11%. There were 2 failures in our study, one was converted to open pyelolithotomy; other one required SWL for residual fragment in inferior calyx. The stone size ranged from 3.8-7.4 cm. Mean analgesic requirement was 910 + 326 mgs and mean hospital stay was 2.3 ± 1.5 days. There were no major complications and none of the patients required blood transfusion.

Discussion: ESWL alone is not a good modality for staghorn calculi. PCNL alone or with ESWL achieves acceptable stone clearance rate but multiple punctures are to be given with heavy blood loss requiring blood transfusions (Table 1).

Conclusions: RPPL is a feasible option for staghorn calculi as it not only achieves complete stone clearance in one sitting but incorporates advantages of minimal invasive surgery as well.

Session: Poster Presentation

Program Number: P537

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