V1995 COMBINED LAPARO-ENDOSCOPIC TREATMENT OF MULTIPLE LARGE STONES OF THE UPPER URINARY TRACT

Abstract

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2010V1995 COMBINED LAPARO-ENDOSCOPIC TREATMENT OF MULTIPLE LARGE STONES OF THE UPPER URINARY TRACT Alessandro Volpe, Francesco Varvello, Roberto Tarabuzzi, Stefano Zaramella, Giansilvio Marchioro, Giovanni Ceratti, Antonella Di Domenico, Ilenia Zanellato, and Carlo Terrone Alessandro VolpeAlessandro Volpe More articles by this author , Francesco VarvelloFrancesco Varvello More articles by this author , Roberto TarabuzziRoberto Tarabuzzi More articles by this author , Stefano ZaramellaStefano Zaramella More articles by this author , Giansilvio MarchioroGiansilvio Marchioro More articles by this author , Giovanni CerattiGiovanni Ceratti More articles by this author , Antonella Di DomenicoAntonella Di Domenico More articles by this author , Ilenia ZanellatoIlenia Zanellato More articles by this author , and Carlo TerroneCarlo Terrone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2007AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We describe the technique of combined laparo-endoscopic treatment of upper urinary tract complex and multiple stones in two patients. In the first case the patient had a 2,2 cm stone in the left lumbar ureter associated with multiple intrarenal stones. In the second case the patient had a nonobstructive enlargement and malformation of renal calyces with a bifid pelvis. Multiple large stones were present in the pelvis and all calyces. METHODS Both procedures were performed with transperitoneal approach. In the first case a ureteral stent was inserted at the time of diagnosis. To expose the left lumbar ureter a transmesocolic access was preferred. After the ureteral incision and the extraction of the large ureteral stone a flexible nephroscopy was introduced. All small stones in superior and inferior calyces were removed with a basket. Larger stones were first fragmented with laser before extraction with basket. The ureterotomy was finally sutured with a running suture and the mesocolic incision was closed after placing a drain. The stones were extracted in endobag. In the second case the epatic flexure and the duodenum were reflected medially and the right renal pelvis was isolated. A pyelotomy was performed allowing the extraction of pelvic stones. Therefore, a flexible nephroscopy was inserted to remove all remaining stones with a basket. The pielotomy was finally closed with a running suture. A drain was inserted. At the end of the procedure a ureteral stent was inserted with a cystoscope. RESULTS In both cases a retrograde cystogram was performed and showed vesico-ureteral reflux without leakage of contrast medium. The patients were discharged stone free in post operative day 4. The ureteral stents was removed twenty days after the procedure. CONCLUSIONS A combined laparo-endoscopic approach can be considered for the treatment of upper urinary tract complex and multiple stones. This technique is minimally invasive and allows a complete stone clearance in a single procedure. Novara, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e775 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Volpe More articles by this author Francesco Varvello More articles by this author Roberto Tarabuzzi More articles by this author Stefano Zaramella More articles by this author Giansilvio Marchioro More articles by this author Giovanni Ceratti More articles by this author Antonella Di Domenico More articles by this author Ilenia Zanellato More articles by this author Carlo Terrone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...