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Abstract

A Comparative Study of Laparoscopic Pyelolithotomy and Percutaneous Nephrolithotomy in the Management of Large Solitary Renal Pelvic Stone

Aims and Objectives: The aim of this study is to compare Laparoscopic Retroperitoneal Pyelolithotomy (LRP) and Percutaneous Nephrolithotomy (PCNL) in the management of large (>2 cm) solitary stones of renal pelvis.

Materials and Methods: This was a prospective randomized study in which patients with solitary renal pelvic stones larger than 2 cm were randomized in to two groups, LRP Group and (PCNL) Group. The characteristics which were compared between the two groups include operative time, intraoperative complications; postoperative pain assessed by visual analogue scale (VAS) score and analgesic requirement, maximum stone clearance, conversion to open pyelolithotomy, postoperative complications and hospital stay.

Results: Stastiscally there was significant difference between the two groups regarding mean operative time 130.57 min LRP Group vs. 71.67 min. PCNL Group, p<0.001, average blood loss 94.5 ml LRP Group vs. 126.17 ml PCNL Group, p=0.032, postoperative pain quantified by VAS score and analgesic requirement 5.06 in first 24 hours LRP Group vs. 2.5 PCNL Group, p<0.001, hospital stay 4.96 days LRP Group vs. 3.7 days PCNL Group, p<0.05. The Intraoperative and postoperative complications were more in LRP Group than the PCNL group but the difference was not statistically significant. Four patients in the LRP group required conversion to open, however no conversion was required in the PCNL group. No difference was noted in the stone clearance between the two groups.

Conclusion: Percutaneous nephrolithotomy is superior to laparoscopic retroperitoneal pyelolithotomy in the management of large size stones of renal pelvis, in terms of operating time, blood loss, analgesic requirement and hospital stay.


Author(s):

Sajad A Para, Sajad A Wani*, Suhail A Malik, Zafer S Khandy and Krishna Murty



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