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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 746-750. doi: 10.19723/j.issn.1671-167X.2022.04.026

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Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi

Li-zhe AN,Liu-lin XIONG*(),Liang CHEN,Huan-rui WANG,Wei-nan CHEN,Xiao-bo HUANG   

  1. Urology and Lithotripsy Center, Peking University People' s Hospital, Peking University Applied Lithotripsy Institute, Beijing 100034, China
  • Received:2022-03-31 Online:2022-08-18 Published:2022-08-11
  • Contact: Liu-lin XIONG E-mail:xiongliulin@sina.com

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Abstract:

Objective: To investigate the efficacy and safety of laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope in the treatment of ureteropelvic junction obstruction (UPJO) with renal calculi. Methods: From June 2016 to January 2022, eight patients including five males and three females underwent laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F(1F≈0.33 mm) nephroscope in Peking University People' s Hospital. The age ranged from 23-51 years (mean: 40.5 years) and the body mass index (BMI) ranged from 18.8-32.4 kg/m2 (mean 27.0 kg/m2). The lesion located on the left side in all of the eight patients. Two patients had solitary kidney and one patient had horseshoe kidney. Solitary stone was seen in one patient and the other seven patients suffered multiple stones, with two patients had staghorn stones. The largest diameter of stones ranged from 0.6-2.5 cm (mean: 1.5 cm). CT or ultrasound showed that moderate nephrosis was seen in five patients and severe nephrosis was seen in three patients. During surgery, after exposure of renal pelvis and proximal ureter, a small incision of 1.5 cm was performed in the anterior wall of the renal pelvis, and a 19.5F nephroscope was introduced into renal pelvis through laparoscopic trocar and renal pelvis incision. Stones were fragmented and sucked out by 3.3 mm ultrasonic probe placed through nephroscope. After stones were removed, modified laparoscopic pyeloplasty was performed. Results: Surgery was successfully completed in all of the eight patients without conversion to open surgery. The operation time ranged from 160-254 min (mean 213 min) and the time of nephroscopic management time was 25-40 min (mean: 33 min). The hemoglobin was decreased by 3-21 g/L (mean: 10.3 g/L). The stone-free rate was 75% (6/8 cases), stones were incompletely removed in two patients due to abnormal intrarenal structure. The modified Clavien classification system (MCCS) grade ⅢA complication occurred in one patient postoperatively, which was nephrosis due to intrarenal bleeding, and nephrostomy was performed. With the mean follow-up of 30 months (ranged from 2-68 months), there was no evidence of obstruction in all the patients, and one patient underwent percutaneous nephrolithotomy to treat residual calculi. Conclusion: Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F nephroscope is feasible and safe, and could be a complementary method to treat UPJO and renal calculi.

Key words: Ureteropelvic junction obstruction, Kidney calculi, Laparoscopy, Pyeloplasty

CLC Number: 

  • R691.2

Figure 1

Procedure of nephroscopic ultrasonic lithotripsy A, the kidney was scanned by laparoscopic ultrasound probe to confirm the location of stones; B, 19.5F nephroscope was introduced into renal pelvic through small incision of renal pelvis; C, the stone was located in a calyx with narrow neck, and it was very difficult to be removed by forceps or basket; D, the stone was fragmented and sucked out by ultrasonic probe."

Figure 2

Preoperative and postoperative KUB images of patient with UPJO and multiple small stones A, preoperative KUB showed a large number of small stones located in lower calyx (white arrow); B, postoperative KUB showed that stones was completely removed. KUB, kidney, ureter and bladder."

Table 1

Clinical data of patients underwent laparoscopic pyeloplasty and nephroscopic ultrasonic lithotripsy"

No. Age/years Gender BMI/(kg/m2) Symptom Side Solitary kidney Degree of nephrosis Staghorn stones Multiple stones Diameter of the largest stone/cm
1 31 Male 25.1 Loin pain Left No Severe No Yes 0.6
2 49 Female 29.8 Loin pain Left No Moderate No No 1.3
3 23 Female 18.8 Loin pain Left No Severe No Yes 1.2
4 48 Male 31.1 None Left No Moderate No Yes 1.2
5 25 Male 32.4 Flank pain Left Yes Moderate Yes Yes 2
6 47 Male 23.7 None Left No Moderate No Yes 2.3
7 50 Female 29.4 Hematuria Left Yes Moderate Yes Yes 2.5
8 51 Male 26.0 Loin pain Left No Severe No Yes 1.1
No. Operative time/min Time of nephroscopic management/min Hb drop/(g/L) Postoperative complication Clavien grade Hospital stay after surgery/d Stone free Stone recurrence Follow-up/ months
1 230 39 14 Yes ⅢA 10 Yes No 68
2 175 25 3 None 5 Yes No 42
3 186 28 8 None 6 Yes No 40
4 207 27 7 None 4 Yes No 37
5 248 40 21 None 4 No Yes 36
6 254 32 9 None 4 Yes No 13
7 247 38 11 None 5 No No 3
8 160 33 9 None 5 Yes No 2
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