Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with percutaneous nephrolithotripsy

Objectives: To evaluate the role of retroperitoneoscopic pyelolithotomy (RPPL) for the management of renal pelvic calculus and its comparison with percutaneous nephrolithotripsy (PCNL). Patients and methods: Eighteen RPPLs were performed between March 1995 and March 2002, and 16 out of these were compared retrospectively with 12 cases of PCNL performed in the year 2000 for solitary renal pelvic stone more than 3-cm in size. Laparoscopic pyelolithotomy was carried out with retroperitoneal approach and subsequent to stone removal pyelotomy was sutured with intracorporeal interrupted sutures. Results: The two groups were similar as regards the patient age and sex. The mean stone sizes in RPPL and PCNL groups were 3.6 and 4.2 cm respectively (p < 0.006). There were 2 conversions in the RPPL group due to stone migration into calyx and dense perirenal adhesions making dissection difficult. The mean operating time was 142.18 min for RPPL as compared to 71.6 min for PCNL (p < 0.000). The blood loss was 173.1 ml in RPPL as compared to 147.9 ml for PCNL (p NS). The mean hospital stay was 3.8 and 3-days in RPPL and PCNL groups respectively. Conclusions: Laparoscopic pyelolithotomy takes longer to perform, more invasive, less cosmetic and requires more skills at present as compared to PCNL. In this limited study it is clearly demonstrated that PCNL is the better treatment modality for renal stones and laparoscopy should be offered to those who needs adjunctive procedure such as pyeloplasty or puncture during PCNL under vision.