Comparative analysis of retro vs. transperitoneal laparoscopic pyelolithotomy for large renal stones.

IF 2 2区医学 Q2 UROLOGY & NEPHROLOGY

Urolithiasis Pub Date : 2024-10-09 DOI:10.1007/s00240-024-01640-w

Hamid Pakmanesh, Mazyar Zahir, Alireza Farshi, Alireza Aminsharifi, Nasrin Borumandnia, Ali Salari, Shadi Setaresobh, Amir Hossein Kashi

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Abstract

The objective of this study is to compare the outcomes and complications of retroperitoneal and transperitoneal laparoscopic pyelolithotomy (RLP and TLP, respectively) in the treatment of large kidney stones. In this retrospective cohort effort, data of all patients who underwent laparoscopic pyelolithotomy for renal pelvic stone (N = 273) in three referral urology hospitals were retrieved. Operation duration, length of hospital stay, postoperative stone-free rate, hemoglobin (Hb) and creatinine (Cr) changes and complications were compared between the two groups before and after propensity score matching. A total of 199 TLP and 74 RLP cases were examined. Stone size was significantly higher in the TLP vs. RLP group (29.8 ± 10.9 vs. 26.5 ± 8.8 mm; P = .022). Length of operation and hospital stay were comparable (P = .672 and P = .396, respectively). Rate of conversion to open surgery, postoperative blood transfusion rate, postoperative urinary leakage, postoperative stone-free rate, Hb drop and Cr change were similar between the two groups (P = .348, 0.190, 0.828, 0.411, 0.780 and 0.134, respectively). Postoperative fever was significantly more prevalent in TLP compared to RLP (21.6% vs. 0.0%, respectively; P < .001). Propensity score matched analyses showed similar results in all aspects; particularly demonstrating higher postoperative fever in TLP compared to RLP (18.9% vs. 0.0%, respectively; P < .001). RLP can be considered as an alternative to TLP; especially owing to a lower chance of postoperative fever.

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后腹腔镜与经腹腔镜肾盂取石术治疗巨大肾结石的比较分析。

本研究旨在比较腹膜后腹腔镜和经腹膜腹腔镜肾盂切开取石术（分别为RLP和TLP）治疗巨大肾结石的疗效和并发症。在这项回顾性队列研究中，我们收集了三家泌尿科转诊医院所有接受腹腔镜肾盂取石术治疗肾盂结石患者（N = 273）的数据。比较了倾向得分匹配前后两组患者的手术时间、住院时间、术后无石率、血红蛋白（Hb）和肌酐（Cr）变化以及并发症。共研究了199例TLP和74例RLP病例。TLP组结石大小明显高于RLP组（29.8 ± 10.9 vs. 26.5 ± 8.8 mm; P = .022）。手术时间和住院时间相当（分别为 P = .672 和 P = .396）。两组患者转为开放手术的比率、术后输血率、术后漏尿率、术后无结石率、Hb 下降率和 Cr 变化率相似（P = .348、0.190、0.828、0.411、0.780 和 0.134）。与 RLP 相比，TLP 的术后发烧率明显更高（分别为 21.6% 对 0.0%；P = 0.5%）。

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来源期刊

Urolithiasis UROLOGY & NEPHROLOGY-

CiteScore

4.50

自引率

6.50%

发文量

期刊介绍： Official Journal of the International Urolithiasis Society The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field. Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.