Retroperitoneoscopic approach for urolithiasis treatment

ABSTRACT

Objective

To show the main indications of retroperitoneoscopy (RP) for the treatment of urolithiasis. The use of RP approach has been limited, being narrow working space the major issue to overcome (1), especially in non-expert hands. However, RP has the added advantages of no peritoneal contamination, a quick recovery of bowel function (2) and the possibility to use it in combination with other endourological techniques (3) and innovative technology.

Materials and Methods

We performed a retrospective analysis of 22 patients treated by the retroperitoneoscopic approach due to urolithiasis disease between 2015-2017. Type of surgery, stone free rate (SFR), complications according to Clavien-Dindo classification and mean hospital stay were recorded. Radical and partial nephrectomy cases were excluded for the SFR calculation. Descriptive statistical analysis was done using SPSS v21.

Results

Of the 22 patients treated by the retroperitoneoscopic approach, 9 underwent a ureterolithotomy, 4 underwent a nephrolithotomy, 8 were nephrectomies and 1 was a polar nephrectomy. In 3 cases we used the indocianine green fluorescence (ICG) to find avascular planes, reduce the bleeding, permitting enhanced visualization and reconstruction. In 3 cases an additional percutaneous approach was used, increasing the SFR chances. Eleven of thirteen (84.6%) patients were stone free following the procedure. Tree complications were recorded, two Clavien II and one Clavien III complications. Mean hospital stay was 4 days.

Conclusions

Retroperitoneoscopic approach is a good alternative for the treatment of large impacted ureteral stones, large pielic stones and for non-functional kidney removal due to stone disease. In expert hands, it can be safely used with a good SFR. The combination with ICG or other endourological techniques is feasible, allowing higher SFR.

REFERENCES

• ¹
  Won YS, Lee SJ, Kim HY, Lee DS. Five-Year Single Center Experience for Retroperitoneoscopic Ureterolithotomy. J Laparoendosc Adv Surg Tech A. 2017;27:128-33.
• ²
  Chipde SS, Agrawal S. Retroperitoneoscopic pyelolithotomy: a minimally invasive alternative for the management of large renal pelvic stone. Int Braz J Urol. 2014;40:123-4;discussion 124.
• ³
  Tepeler A, Akman T, Tok A, Kaba M, Binbay M, Müslümanoğlu AY, et al. Retroperitoneoscopic nephrectomy for non-functioning kidneys related to renal stone disease. Urol Res. 2012;40:559-65.

Publication Dates

• Publication in this collection
  01 June 2020
• Date of issue
  Jul-Aug 2020

History

• Received
  11 Feb 2019
• Accepted
  31 May 2019
• Published
  10 Aug 2019