Laparoscopic Pyelolithotomy for treating urolithiasis in ectopic pelvic kidneys

Goumas, Ioannis Kartalas; Tondelli, Elena; Bevilacqua, Luigi; Oliva, Isabella; Orecchia, Luca; Wroclawski, Marcelo Langer; Giusti, Guido; Proietti, Silvia; Miano, Roberto; Ventimiglia, Eugenio

doi:10.1590/S1677-5538.IBJU.2023.0148

ABSTRACT

Introduction:

The management of urolithiasis ectopic pelvic kidneys (EPK) can be challenging because of the aberrant anatomy (¹1 Salvi M, Muto G, Tuccio A, Grosso AA, Mari A, Crisci A, et al. Active treatment of renal stones in pelvic ectopic kidney: systematic review of literature. Minerva Urol Nefrol. 2020;72:691-7.–⁴4 Al-Yousef R, Almarzouq A, Aldousari S. Robotic pyelolithotomy in a congenital pelvic kidney: side docking and robotic prostatectomy port - site approach. Int Braz J Urol. 2017;43:374.). We demonstrate the step-by-step technique of the laparoscopic approach for treating urolithiasis in EPK.

Patients and methods:

Three men with EPK (2 left, 1 right) underwent laparoscopic pyelolithotomy through a transperitoneal approach. After establishing the pneumoperitoneum, the parietal peritoneum was opened at the parietal colic sulcus and the bowel displaced medially. The kidney was identified in the retroperitoneum and the renal pelvis exposed after removal of the perirenal adipose tissue. The renal pelvis was opened, and the stones were identified and retrieved with forceps in 2 cases and with a flexible nephroscope in 1 case. The renal pelvis was closed with a 3/0 running barbed suture. A DJ stent was placed in all patients.

Results:

For the first time, a laparoscopic technique for treating stones in the ectopic kidney is demonstrated in detail. Mean patient age was 52.6 years (44-58). The mean stone size was 22.3 mm (20-24 mm). Stones were in the renal pelvis in 2 cases and in the inferior calyx in 1 case. Mean operative time was 146 minutes (135-155 min). Mean estimated blood loss was 116 ml (60-140 ml). No complications were observed. The mean hospital stay was 3 days. The DJ stents were removed after 3 weeks. All patients were stone free at the postoperative CT scan with a mean follow-up of 3.3 months (1-6 months).

Conclusions:

Laparoscopic pyelolithotomy can be an effective and reproducible minimally invasive technique for treating urolithiasis in EPK.

Available at: http://www.intbrazjurol.com.br/video-section/20230148_goumas_et_al

Int Braz J Urol. 2023; 49 (Video #11): 646-7

REFERENCES

¹
Salvi M, Muto G, Tuccio A, Grosso AA, Mari A, Crisci A, et al. Active treatment of renal stones in pelvic ectopic kidney: systematic review of literature. Minerva Urol Nefrol. 2020;72:691-7.
²
Lavan L, Herrmann T, Netsch C, Becker B, Somani BK. Outcomes of ureteroscopy for stone disease in anomalous kidneys: a systematic review. World J Urol. 2020;38:1135-46.
³
Elbahnasy AM, Elbendary MA, Radwan MA, Elashry OM, Taha MR. Laparoscopic pyelolithotomy in selected patients with ectopic pelvic kidney: a feasible minimally invasive treatment option. J Endourol. 2011;25:985-9.
⁴
Al-Yousef R, Almarzouq A, Aldousari S. Robotic pyelolithotomy in a congenital pelvic kidney: side docking and robotic prostatectomy port - site approach. Int Braz J Urol. 2017;43:374.

Publication Dates

Publication in this collection
01 Sept 2023
Date of issue
Sep-Oct 2023

History

Received
05 Apr 2023
Accepted
12 Apr 2023
Published
15 May 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Salvi M, Muto G, Tuccio A, Grosso AA, Mari A, Crisci A, et al. Active treatment of renal stones in pelvic ectopic kidney: systematic review of literature. Minerva Urol Nefrol. 2020;72:691-7.

[2] ²
Lavan L, Herrmann T, Netsch C, Becker B, Somani BK. Outcomes of ureteroscopy for stone disease in anomalous kidneys: a systematic review. World J Urol. 2020;38:1135-46.

[3] ³
Elbahnasy AM, Elbendary MA, Radwan MA, Elashry OM, Taha MR. Laparoscopic pyelolithotomy in selected patients with ectopic pelvic kidney: a feasible minimally invasive treatment option. J Endourol. 2011;25:985-9.

[4] ⁴
Al-Yousef R, Almarzouq A, Aldousari S. Robotic pyelolithotomy in a congenital pelvic kidney: side docking and robotic prostatectomy port - site approach. Int Braz J Urol. 2017;43:374.

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