Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy

ABSTRACT Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.摘要 研究目的：本研究旨在评估同期联合肾盂切开取石术的腹腔镜肾盂成形术的治疗效果，并将其与仅行腹腔镜肾盂成形术（未同期行肾盂切开取石术）的患者队列进行对比分析。 材料与方法：回顾性分析2012年12月至2018年7月于我科行经腹腔腹腔镜Anderson-Hynes离断式肾盂成形术的43例患者的临床资料。其中18例（42%）患者接受同期联合肾盂切开取石术的腹腔镜肾盂成形术。将合并肾结石的患者与25例匹配的未合并肾结石、仅行腹腔镜肾盂成形术的患者进行对比，比较两组的人口统计学资料、手术及结石相关参数。 结果：两组患者的人口统计学特征无显著差异。所有手术均顺利完成腹腔镜操作，无中转开放手术病例。其中无肾结石组3例、合并肾结石组15例因血管交叉而行输尿管移位术。合并肾结石患者的平均结石直径为13±5.24 mm，结石数量中位数为1（范围1~18）。术后3个月利尿肾图检查结果均为阴性，提示同期联合肾盂切开取石术组与单纯肾盂成形术组的腹腔镜肾盂成形术成功率分别为93.3%与92.9%。同期行肾盂切开取石术患者的总体无结石率为93.3%。同期联合组与单纯组的平均手术时间分别为222.67±65.71 min与219.11±75.63 min（p=0.88）。 结论：同期联合肾盂切开取石术的腹腔镜肾盂成形术是一种安全有效的治疗手段，具有良好的美容效果与较高的无结石率，且未显著增加手术时间或并发症发生率。