Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients

OBJECTIVES: To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3–4 cm) in patients with chronic liver disease or coronary artery disease. PATIENTS AND METHODS: In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated. RESULTS: The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak. CONCLUSION: LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.