Transabdominal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for renal pelvic stones or ureteral stones larger than 2 cm

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Objective To explore the safety and efficacy of transabdominal laparoscopic pyelolithotomy(LP) versus percutaneous nephrolithotomy(PCNL) for renal pelvic stones or uretetal stones larger than 2 cm. Methods 40 patients with renal pelvic stones or ureteral stones larger than 2 cm treated at our department from February, 2016 to May, 2017 were selected and divided into an LP group (n=17) and a PCNL group (n=23). The LP group were treated with transabdominal laparoscopic pyelolithotomy (LP) and the PCNL group with percutaneous nephrolithotomy (PCNL). The mean operation time, intra-operative bleeding volume, serum creatinine level, stone-free rate in one session, surgical complications, blood transfusion rate, and mean hospital stay were compared between these two groups. Results The mean operation time was (90±8.4) min in the LP group and was (85±4.4) min in the PCNL group, with no statistical difference. The intra-operative bleeding volume, stone-free rate in one session, hospital stay, and serum creatinine level were (18.82±0.91) ml, 100.0%, (10.17±0.39) d, and (95.5±5.4) μmol/L in the LP group and were (46±9.41) ml, 65.2%, (12.39±0.79) d, and (162.5±25.6) μmol/L in the PCNL group (all P<0.05) . During the operation, no patients got complications in the LP group, while 2 cases had hypotension and 4 cases perforation of renal pelvis in the PCNL group. After the operation, 1 case had hematuria and 1 fever in the LP group, while 5 cases had hematuria, 6 cases fever, 3 cases increase of SCr in the PCNL group. There were statistical differences in the incidences of intraoperative and postoperative complications between these two groups. Conclusions LP has more higher stone clearance rate, less bleeding, fewer intraoperative and postoperative complications, and can maximize the protection of renal function in the treatment of renal pelvis or ureteral calculi larger than 2 cm, so it is worth for clinical application. Key words: Laparoscopic pyelolithotomy; Percutaneous nephrolithotomy; Renal pelvic or uretetal stones; Stone-free rate