Secondary Stones Research Articles

The 1-cm lower calyx calculus: SWT, URS or Mini-PCNL? Guidelines vs. reality.

Urinary stones of the upper urinary tract can be considered a widespread public health concern due to their high incidence and prevalence and their health policy-related and financial implications. A significant proportion of newly diagnosed kidney stones are lower-pole stones, i.e., stones affecting the lower calyx group of the renal pelvicalyceal system. These are often diagnosed by chance, i.e., as incidental findings during ultrasound or CT scans performed for other reasons, or as "secondary stones" detected during the diagnostic work-up of symptomatic urinary stones in other locations. Residual disintegrates after extracorporeal shock-wave lithotripsy (ESWL) or endoscopic stone therapy constitute a further, quantitatively significant group. These incidentally discovered lower-pole stones are often characterised by their small size and lack of symptoms. It stands to reason that some of these small, asymptomatic lower-pole stones do not always remain small and asymptomatic, and that treatment tends to become more complex with increasing size. There has been an astonishing lack of published studies with a high level of evidence over the last 20 years to provide a conclusive and reproducible answer to the question posed in this review. Small, asymptomatic stones can be monitored. Symptomatic and rapidly growing stones should be treated. There is a lack of valid risk factors allowing an identification of subgroups that should be treated prophylactically at the asymptomatic stage. In active therapy, a 10-to-20-year-old principle still holds true today: a high stone-free rate in one therapy session is offset by an increased complication rate, with increasing miniaturisation in endourology (retrograde and percutaneous) and increasingly effective laser disintegration shifting this basic principle more and more in favour of flexible URS and (mini, micro) PCNL. The range of indications for ESWL is undoubtedly becoming smaller, and this also applies to lower-pole stones. The results of an ongoing prospective randomised study comparing the different treatment modalities, albeit with recruitment difficulties, are still pending.

2023 Update in ambulatory general internal medicine.

The practice of outpatient medicine is demanding, encompasses a wide scope of practice, and leaves little time for internists to stay up to date with the current literature. This article reviews 5 studies published in 2022 and 2023 that have the potential to change the practice of outpatient medicine. Topics covered include chronic kidney disease, secondary cardiovascular disease, kidney stones, obesity, and lipid management.

Vesical calculus: A harbinger for posterior urethral valve?

Bladder stones are of two varieties, primary which are not associated with Urinary Tract Infection (UTI), Bladder Outlet Obstruction (BOO) or foreign bodies and secondary bladder stones which are associated with either or all of the above-mentioned entities. We report three cases of male patients with bladder calculi without any specific history suggestive of BOO since birth. In one of them, posterior urethral valve was found to be the cause of urinary leak on post-operative day 6th after cystolithotomy. In the other two, we had performed cystoscopy before planned cystolithotomy. We recommend through this article that all boys with bladder stones should have diagnostic cystoscopy, especially where endo-urology is available, before proceeding for cystolithotomy.

The Role of Experience: How Case Volume and Endourology-Fellowship Training Impact Surgical Outcomes for Ureteroscopy.

Introduction: Surgical experience is associated with superior outcomes in complex urologic cases, such as prostatectomy, nephrectomy, and cystectomy. The question remains whether experience is predictive of outcomes for less complex procedures, such as ureteroscopy (URS). Our study examined how case volume and endourology-fellowship training impacts URS outcomes. Methods: We retrospectively reviewed URS cases from 2017 to 2019 by high ureteroscopy volume urologists (HV), low ureteroscopy volume urologists (LV), endourology-fellowship trained (FT), and non-endourology FT (NFT) urologists. Surgical outcomes including stone-free rate (SFR), complication and reoperation rates, and postoperative imaging follow-up were analyzed between groups. Results: One thousand fifty-seven cases were reviewed across 23 urologists: 6 HV, 17 LV, 3 FT, and 20 NFT. Both FT and HV operated on more complex cases with lower rates of pre-stented patients. HV also operated on patients with higher rates of renal stones, lower pole involvement, and prior failed procedures. Despite this, FT and HV showed between 11.7% and 14.4% higher SFR, representing 2.7- to 3.6-fold greater odds of stone-free outcomes for primary and secondary stones. Additionally, HV and FT had a 4.9% to 7.8% lower rate of postoperative complications and a 3.3% to 4.3% lower rate of reoperations, representing 1.9- to 4.0-fold lower odds of complications. Finally, their patients had a 1.6- to 2.1-fold higher odds of postoperative imaging follow-up with a greater proportion receiving postoperative imaging within the recommended 3-month postoperative period. Conclusions: More experienced urologists, as defined by higher case volume and endourology-fellowship training, had higher SFR, lower complication and reoperation rates, and better postoperative imaging follow-up compared with less experienced urologists. Although less experienced urologists had outcomes in-line with clinical and literature standards, continued training and experience may be a predictor of better outcomes across multiple URS modalities.

Calculus Formation in Bladder from Migrated Intrauterine Devices

Migration of the intrauterine device (IUD) into the bladder has been a rare case. There were reported 31 cases of IUD migration into the bladder until 2006. Although IUD migration is asymptomatic, it should be removed to prevent complications such as pelvic abscess, bladder or intestinal rupture, and adhesion. A 52-year-old woman came to the urology clinic with pyuria since the previous 3 months. She had a history of IUD insertion in 1982; and two months later, she got pregnant. Since 2015, she has suffered from dysuria but has never been treated and has worsened in the past 3 months. On physical examination, tenderness was found in the suprapubic region. The results of urinalysis showed pyuria and hematuria. The ultrasonography findings, there were large bladder stones. An abdominal x-ray revealed the presence of a bladder stone with the IUD tail. Vesicolithotomy was performed and the IUD was found attached to an 11x7 cm bladder stone. The patient had a good postoperative condition without any special complications. The IUD in the bladder is a medium for forming secondary bladder stones. Most cases of IUD migration are caused by a lack of evaluation after the installation procedure. This case suggested that the physician should be more careful in carrying out the installation procedure. It is necessary to evaluate the location of the IUD after installation to prevent further patient complications.

Primary Recurrent Common Bile Duct Stones: Timing of Surgical Intervention.

Cholelithiasis (gallstones) is a very common medical problem worldwide, with 5-30% of patients demonstrating a combined condition of cholelithiasis and choledocholithiasis (common bile duct stones (CBDS)). CBDS are usually classified as primary or secondary stones. Primary CBDS are defined as stones detected 2 years or more following cholecystectomy, while secondary stones, the most common type, usually migrate from the gallbladder to the bile ducts. Recurrent CBDS are defined as stones detected 6 months or more following endoscopic retrograde cholangiopancreatography (ERCP) with complete duct clearance. Although ERCP with endoscopic sphincterotomy has emerged as the main therapeutic option for CBDS, with up to 95% bile duct clearance rate, up to 25% of said patients develop recurrent bile duct stones. Thus far, several issues related to recurrent CBDS are still unclear and questions regarding this specific pathology have no precise answers: how many trials of ERCP and endoscopic sphincterotomy should be attempted before referring the patient for surgical management? Is there an association between risk factors and early surgical intervention? Thus, currently, there is no worldwide scientific-based consensus regarding the best management of this specific group of patients. The main issue for this article is to review the relevant English literature and find out the main high risk factors for recurrent CBDS, and form a diagnostic and treatment plan, hence, identifying the subgroup of patients that will benefit from early surgical management, preventing further ERCP-associated complications.

Secondary kidney stones - remove or leave?

Secondary kidney stones - remove or leave?

Weathered Cortex of Eluvial–Deluvial Jadeite Jade from Myanmar: Its Features, Formation Mechanism, and Implications

Myanmar is the principal provider country of high-quality jadeite jade in the world, including so-called primary and secondary stones. The secondary stones occur as rounded pebbles, boulders, and blocks in eluvium–alluvium and often hold varying degrees of weathering. Unlike common rocks, such as granite, gabbro, schist, gneiss, and amphibolite, secondary jadeite stones frequently have weathered cortexes that vary in appearance, depth, texture, and mineral components compared with those of inner primary bodies. In this study, representative samples of secondary eluvial–deluvial jadeite stones with varying weathered cortexes were selected, and their appearances, textures, mineral components, and chemical composition features were analyzed. Their weathered cortexes were red, yellow, white, or black, and were 0.01–1.80 cm thick. The cortexes were opaque, often with soil luster and a fansha phenomenon. The body of the jade was usually translucent, and green and white in color. Along the border between the weathered cortex and the body of a certain jade stone, the textures were the same for the successive grain sizes. The only difference was that there were more cracks, cleavage planes, and fissures in the cortex. Jadeite was the main mineral component of both; however, minor late-stage supergene minerals (such as gibbsite, kaolinite, and halloysite) and Fe-bearing colloidal minerals were identified along the grain boundaries in the cortex. Studies of the textures and mineral components of weathered cortexes have gemmological applications including the identification and grading raw jadeite, as well as its design and carving. Moreover, such studies might provide information for improving our understanding of the unique weathering processes of monomineralic aggregates relative to multiple-mineral rocks, as well as gambling jadeite jade pieces through analyzing their cortex.

Patients with Primary and Secondary Bile Duct Stones Harbor Distinct Biliary Microbial Composition and Metabolic Potential

IntroductionCholelithiasis has a high incidence worldwide and limited treatment options due to its poorly understood pathogenesis. Furthermore, the role of biliary microbiota in cholelithiasis remains understudied. To address these questions, we performed microbial sequencing from biliary samples from primary bile duct stone (PBDS) and secondary bile duct stone (SBDS) patients.ResultsWe analyzed in total 45 biliary samples, including those from cholelithiasis patients with PBDS or SBDS and people with other digestive diseases. 16S rRNA sequencing showed the bacteria family Alcaligenaceae increased in relative abundance in the lithiasis group compared with the non-lithiasis group. In addition, the PBDS group showed significantly lower bacterial diversity than SBDS, with Propionibacteriaceae, Sphingomonadaceae, and Lactobacillaceae as the most significant bacteria families decreased in relative abundance. We further performed whole metagenomic shotgun sequencing (wMGS) and found increased ability of biofilm synthesis and the ability to sense external stimuli in PBDS based on functional annotation of mapped reads. From genome-resolved analysis of the samples, we identified 36 high-quality draft bacterial genome sequences with completion ≥70% and contamination ≤10%. Most of these genomes were classified into Proteobacteria, Firmicutes, or Actinobacteria.ConclusionsOur findings indicated that there is a subtle impact on biliary microbiome from cholelithiasis while the difference is more pronounced between the PBDS and SBDS. It was revealed that the diversity of biliary microbiota in PBDS is lower, while some metabolic pathways are up-regulated, including those linked to higher incidence of different types of cancer, providing new insights for the understanding of cholelithiasis with different origin.

Guy’s stone Scoring in Predicting Post operative Residual Stones

Objective: To determine the frequency of postoperative residual stone based on preprocedural Guy’s scoring system.Methodology: This cross-sectional descriptive study was conducted from1st June 2018 to 30th November 2019 at University Medical College Faisalabad. All patients with stones in the kidney undergoing PCNL, 20 to 60 years of age of both genders were included. Patients with secondary stones due to pelviureteric junction obstruction, CRF and recurrent stones were excluded. In all patients Guy’s scoring was measured. Then all patients underwent PCNL. After 24 hours of operation, CT scan was done in each patient and residual stone (present/absent) was noted.Results: This study was comprised of 91 patients of age ranged from 20- 60 years. Fifty-three patients (58.24%) were males and 38 (41.76%) females. Seven (7.69%) were of Guy’s grade I, 48(52.75%) grade II, 21(23.08%) grade III and 15 of grade IV. Number of patients with residual stone was 09 (9.89%), 0.0% of GS 1, 12.5% of GS 2, 4.76% of GS 3 and 13.33% of GS 4 patients had residual stone.Conclusion: Pre-PCNL Guy’s scoring is easy, rapid and useful for predicting the residual stone after percutaneous nephrolithotomy. Keywords: Percutaneous nephrolithotomy, Guy’s scoring system, residual stone.

Laparoscopic choledochoduodenostomy: Old wine new bottle

BACKGROUND: Choledocholithiasis is a common medical condition in medical sciences requiring intervention. Among various available techniques Choledochoduodenostomy (CDD),the old age technique is being performed by laparoscopic means. AIM: To study the Laparoscopic choledochoduodenostomy as a surgical option in case of choledocholithiasis. PATIENTS AND METHODS:This is a prospective study, conducted on 159 patients, diagnosed as a case of choledocholithiasis and operated through laparoscopic CDD, and later on followed up to three year in a structured manner for early and long term complications esp. Sump syndrome. RESULTS: Abdominal pain with jaundice was most common presenting complaint. 65.40% had secondary stones, while 10.06% and 5.66% had retained and recurrent stones respectively.8.5% had alkaline reflux gastritis in post operative period , which was managed conservatively, none developed Sump syndrome. CONCLUSION: Laparoscopic CDD is one of the minimally invasive option for choledocholithiasis with less complications.

AACE2021-A-1082: Primary Hyperparathyroidism: A Case Report of Management with Extra Ordinary Low Dose of Cinacalcet in an Elderly Male

Primary Hyperparathyroidism is a common cause of Hypercalcemia and is often seen in endocrine clinics. Majority of patients are found to have solitary parathyroid adenomas which may be associated with other endocrine problems. Common systemic complications are secondary osteoporosis, renal stones, pancreatitis and peptic ulcers. Surgery remains the mainstay of treatment for correction of pathology, however patients who do not meet the criteria or in whom surgery is contraindicated are managed conservatively and with calcimimetic agents such as cinacalcet. Case report and literature review. We are reporting a case of a 73 years old male who was referred to the endocrine clinic for work up of hypercalcemia. His past medical history was significant for well controlled Type 2 Diabetes and Hypertension. During his work up, he was found to have elevated serum calcium of 11.7 mg/dl, elevated serum PTH of 767 ng/L and 24 hours urinary calcium excretion of 446 mg/dl. Renal functions and 25 hydroxy vitamin D levels were within normal limits and the ultrasound and DEXA scan were negative for presence of any renal stone or osteoporosis. His two elder brothers also had a history of parathyroidectomy. He was reluctant for surgery and therefore imaging for the neck was also omitted. He was started on cinacalcet 15 mg/ day with an initial presumption of increase in dose requirement afterwards. However his serum calcium levels showed a remarked improvement and within one month they dropped to 9.9 mg/dl. The second subsequent test showed a serum calcium of 8.9 mg/dl after which the dose was reduced to 15 mg every alternate day. A presumption of tumor necrosis was made but the calcium levels rose higher on stopping cinacalcet and again went back to normal on the extra ordinary low dose of 15 mg every alternate day. His 3 years follow up to our clinic on this maintenance dose has shown steady calcium levels, improvements in serum PTH with fluctuations between 260 – 380 ng/L and no subsequent complication. Primary Hyperparathyrodism is a common cause of hypercalcemia which if left untreated can have serious systemic complications. Surgery remains the mainstay of treatment but in patients not meeting the criteria or in whom surgery is contraindicated, medical therapy is an option which includes dietary measures, bisphosphonates and calcimimetics like cinacalcet. The usual dose of cinacalcet is between 30 – 90 mg/day. Our case represents an unusual story of improvement on a very low dose of calcimimetic. More cases need to be evaluated and tested on low dose and may-be we can have a change in the recommendations in future.

Persistent dysuria in women: etiological diagnostics and treatment

INTRODUCTION: Dysuria is a painful urination combined with its frequency and/or difficulty. Dysuria is observed in many urological diseases and is one of the most common reasons for treatment for urological cause.
 AIM: The aim of the study is to identify the etiological factors of dysuria in women and to evaluate a personalized approach to their treatment.
 MATERIALS AND METHODS: We analyzed the data of 368 women with chronical cystitis. The inclusion criteria for the study were the presence of dysuria (painful and frequent urination more than 8 times a day with or without difficulty), the prescription of urination disorders over one year old and age 18 and over. All patients underwent a comprehensive urological examination to identify the causes of urinary disorders.
 RESULTS: The Bacterial cystitis was confirmed only in 78 (21.2%) patients among all 368 women. In the remaining 290 (78.8%) patients, the causes of persistent dysuria were other diseases: bladder leukoplakia in 154 (41.8%), bladder pain syndrome/interstitial cystitis in 38 (10.3%), viral cystitis in 34 (9.3%), paraurethral formations in 29 (7.9%), neurogenic urinary dysfunction bladder in 25 (6.8%), urethral pain syndrome in 5 (1.4%) patients. Dysuria was also caused by postradiation cystitis (2 patients), secondary stones in the urinary bladder (2 patients), and one patient had extragenital endometriosis.
 CONCLUSIONS: The variety of reasons for the development of persistent dysuria in women requires careful examination of patients. Treatment should be carried out only after accurate verification of the diagnosis.

Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction.

Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function.Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA).Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p < 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%)Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.

Choledocholithiasis without cholecystolithiasis, after endoscopic retrograde cholangiopancreatography follow-up without cholecystectomy

Objective: The widespread use of imaging methods increases the diagnosis and incidence of cholelithiasis. In recent years, the management of patients with cholelithiasis has improved significantly owing to significant advances in the surgical and endoscopic intervention. Materials and Methods: Between February 2015 and January 2018, the data of patients who underwent ERCP at our institution were collected prospectively and analyzed retrospectively. Forty-four patients included in the study were patients with choledocholithiasis without stones in the GB. Results: The mean age of 52 subjects (group A) included in the study was 64.83 ± 17.06, of which 23 (44.2%) were &amp;lt;65 years old and 29 (55.8%) were ≥65 years old. Twenty-four (46.2%) women and twenty-eight (53.8%) men were included in the study. Malignancy was suspected in 6 (11.5%) patients and no suspicion of malignancy was confirmed after Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedure. In group A, 14 patients (26.9%) required a second ERCP, while in group B, the number of patients requiring a second ERCP was 163 (21.3%). The mean length of hospital stay in group A and group B patients was 5.29 ± 3.38 and 6.29 ± 5.39, respectively, and the average cost was 474 $ ± 286 $ and 564 $ ± 664 $, respectively, with no statistical difference between the groups. Conclusions: In conclusion, we think that in patients with secondary or primary choledochal stones without gallstones and with functional GB might be following up without cholecystectomy after the stone is removed from the bile duct by ERCP

English

BACKGROUND Extra-hepatic biliary tract obstruction can be due to a number of conditions. Most causes are due to stones in the common biliary duct or due to malignant obstruction. Malignant causes include carcinoma head of pancreas, periampullary carcinoma and cholangiocarcinoma. Besides calculus and malignant obstruction, benign and malignant strictures can also cause obstruction of extra hepatic biliary ducts. The objectives of the study were to describe the clinical profile of patients presenting with extra-hepatic biliary obstruction and to assess the known aetiological factors. METHODS The research was designed as a hospital based cross-sectional study in the general surgery wards of our institution from 2016 to 2017. All individuals who were diagnosed to have extra-hepatic biliary obstruction by imaging were included in the study. RESULTS Among the 66 cases studied, majority were due to malignancies and gall stones. The malignancies included carcinoma head of pancreas, periampullary carcinoma, cholangiocarcinoma and Klatskin’s tumour. Miscellaneous causes were bile duct stricture, cholelithiasis with biliary sludge and annular pancreas. For the malignant cases, Whipple surgery and its pylorus-preserving variant were the most common surgical procedures carried out. Biliary bypass procedures were also carried out in some patients. For patients with common bile duct (CBD) stones, cholecystectomy, choledocholithotomy and choledochojejunostomy were done. CONCLUSIONS Malignant causes of jaundice are more common than benign causes. Secondary stones are the commonest cause of non-malignant biliary obstruction. Jaundice is more severe and associated with pruritis and more intolerable and persistent in malignancy. Surgical bypass procedures give good palliation for obstructive jaundice. KEY WORDS Bile Ducts, Choledocholithiasis, Cholestasis, Extra Hepatic, Pancreatic Cancer, Periampullary Cancer

Giant staghorn common bile duct calculus: a case report

A bile duct stone is defined as large if it is more than 15mm in size and giant when it is 5cm or more. Giant staghorn calculi are usually uncommon but can be found in oriental cholangio-hepatitis and usually pigment stones. Bile infection appears to be the initial event leading to stone formation. The primary bile duct stones form within the bile ducts and usually of brown pigment type while secondary bile duct stones arise from gall bladder and intra or extra hepatic ducts. There are very few published reports which describe a giant staghorn calculus in the common bile duct (CBD). The purpose of this case report is to report a new rare case of giant staghorn CBD calculus and discuss the diagnostic and surgical approach because staghorn calculi are very rare in the biliary tract.

GIANT STAGHORN COMMON BILE DUCT CALCULUS: A CASE REPORT

A bile duct stone is defined as large if it is more than 15mm in size and giant when it is 5cm or more. Giant staghorn calculi are usually uncommon but can be found in oriental cholangio-hepatitis and usually pigment stones. Bile infection appears to be the initial event leading to stone formation. The primary bile duct stones form within the bile ducts and usually of brown pigment type while secondary bile duct stones arise from gall bladder or intra or extra hepatic ducts. There are very few published reports which describe a giant staghorn calculus in the common bile duct (CBD). The purpose of this case report is to report a new rare case of giant staghorn CBD calculus and discuss the diagnostic and surgical approach because staghorn calculi are very rare in the biliary tract.

1398 A Stone in the Wall: Extraction of an Embedded Choledocholithiasis in the Proximal CBD by Cholangioscopy

INTRODUCTION: Primary choledocholithiasis are stones formed in the common bile duct as opposed to secondary stones when they originate in the gallbladder and pass through. Symptomatic choledocholithiasis are usually managed by cholecystectomy but the CBD stones post cholecystectomy are not uncommon. The rate of recurrence of symptomatic CBD stone range from 4% to 24%. Having a stone impacted in the wall has never been reported before. CASE DESCRIPTION/METHODS: A 74-year-old man with a history of cholecystectomy for symptomatic cholelithiasis presented for one-year history or right upper quadrant colicky pain. He had recurrent CBD stones for four years before presentation. He underwent multiple endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stones removal multiple times. He had a CBD stent. Medical history is also relevant for atrial fibrillation on rivaroxaban and CAD on aspirin. Upon initial evaluation vitals were stable, physical examination was only relevant for RUQ abdominal tenderness. Imaging including computed tomography scan and an ultrasound revealed stable CBD dilation at 1.1 cm with no stones or intrahepatic biliary duct dilation. ERCP was performed with a cholangiogram showing multiple small filling defects in the CBD consistent with small stones. Sludge and stones were removed using a biliary stone extraction balloon. The duct was swept multiple times and no more stones were noted. The pain did not resolve. A repeat ERCP with a cholangioscopy using the spyglass system was performed. It revealed a normal CBD ductal walls, however closer to the bifurcation of the cystic duct, a small stone was noted; it was impacted in the wall. It was retrieved using a spyglass forceps. DISCUSSION: CBD stones are common after cholecystectomy. They are formed in the bile duct in situ and usually occur 12 months after surgery. Risk factors are the presence of multiple CBD stones and type 1 or 2 periampullary diverticulum. Cholangioscopy is sometimes needed as in our case to check for any stone that is impacted or left in the proximal common bile duct.

Laparoscopic pyelolithotomy in treating extra-renal pelvic calculi at Sanglah General Hospital: a case series

Background: This study aims to describe our initial experience in treating extra-renal pelvic calculi using retroperitoneal laparoscopic pyelolithotomy techniques in Urology Division, Department of Surgery, Sanglah hospital, Bali.Case Description: There were seven patients enrolled with extra-renal pelvic calculi in this study whereas two of them accompanied by calyx inferior secondary stones. All the patients underwent retroperitoneal laparoscopic pyelolithotomy with DJ Stent applied. The operating time was improving in each procedure, with average time was 110 minutes, VAS at the first day post-operative was 1-2, a drain was removed on the second day, one of them was extended until the sixth day, most patients was discharged on postoperative day 3. All patients were stented for 3 to 4 weeks; The stents were removed with office cystoscopy. All patients were stone free on follow-up imaging.Conclusion: Retroperitoneal laparoscopic pyelolithotomy is a safe alternative for the management of pelvic renal calculi with minimal post-operative pain and shorter length of stay.