Objective: To present our technique of laparoscopic pyeloplasty (LP) with concomitant pyelolithotomy in ureteropelvic junction obstruction (UPJO) complicated by renal calculi and compare outcome with a group of UPJO patients undergoing modified LP without coexistent calculi. Materials and Methods: We retrospectively reviewed the charts of 51 UPJO patients undergoing modified LP from January 2013 to November 2016 at our institution. Sixteen patients were diagnosed as UPJO with coexistent ipsilateral renal calculi and underwent pyelolithotomy using our modified technique at the time of modified LP. The outcome data of this group were compared with those of 16 matched patients undergoing modified LP without calculi. Results: No conversion to open surgery occurred. The mean operative time for modified LP and pyelolithotomy was 151.6 min, while the mean operative time for modified LP was 137.6 min (p = 0.21). Additionally, no differences in estimated blood loss (p = 0.96) or postoperative complications (p = 1.00) were observed between the 2 groups. The stone-free rate was 100%. During a mean follow-up of 27.1 months, there were no recurrent calculi or secondary UPJO. Conclusions: The combination of our novel flexible guiding tube and modified suture technique provides a practical and economic approach with satisfying outcome in the treating of UPJO with concomitant renal calculi.

Keywords:
Ureteropelvic junction obstruction, Renal calculi, Modified laparoscopic pyeloplasty, Flexible cystoscope, Flexible guiding tube
1.
Bachmann A, Ruszat R, Forster T, Eberli D, Zimmermann M, Müller A, Gasser TC, Sulser T, Wyler S: Retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO): solving the technical difficulties. Eur Urol 2006; 49: 264–272.
2.
Badalato GM, Hemal AK, Menon M, Badani KK: Current role of robot-assisted pyelolithotomy for the management of large renal calculi: a contemporary analysis. J Endourol 2009; 23: 1719–1722.
3.
Badani KK, Hemal AK, Fumo M, Kaul S, Shrivastava A, Rajendram AK, Yusoff NA, Sundram M, Woo S, Peabody JO, Mohamed SR: Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study. World J Urol 2006; 24: 198–201.
4.
Agarwal A, Varshney A, Bansal BS: Concomitant percutaneous nephrolithotomy and transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction complicated by stones. J Endourol 2008; 22: 2251–2255.
5.
Srivastava A, Singh P, Gupta M, Ansari MS, Mandhani A, Kapoor R, Kumar A, Dubey D: Laparoscopic pyeloplasty with concomitant pyelolithotomy – is it an effective mode of treatment? Urol Int 2008; 80: 306–309.
6.
Ball AJ, Leveillee RJ, Patel VR, Wong C: Laparoscopic pyeloplasty and flexible nephroscopy: simultaneous treatment of ureteropelvic junction obstruction and nephrolithiasis. JSLS 2004; 8: 223–228.
7.
Stein RJ, Turna B, Nguyen MM, Aron M, Hafron JM, Gill IS, Kaouk J, Desai M: Laparoscopic pyeloplasty with concomitant pyelolithotomy: technique and outcomes. J Endourol 2008; 22: 1251–1255.
8.
Ramakumar S, Lancini V, Chan DY, Parsons JK, Kavoussi LR, Jarrett TW: Laparoscopic pyeloplasty with concomitant pyelolithotomy. J Urol 2002; 167: 1378–1380.
9.
Atug F, Castle EP, Burgess SV, Thomas R: Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery. BJU Int 2005; 96: 1365–1368.
10.
Eden CG, Moon DA, Gianduzzo T: Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery. BJU Int 2006; 97: 653–654.
11.
Jensen PH, Berg KD, Azawi NH: Robot-assisted pyeloplasty and pyelolithotomy in patients with ureteropelvic junction stenosis. Scand J Urol 2017; 51: 323–328.
12.
Bernardo NO, Liatsikos EN, Dinlenc CZ, Kapoor R, Fogarty JD, Smith AD: Stone recurrence after endopyelotomy. Urology 2000; 56: 378–381.
13.
Nadu A, Mottrie A, Geavlete P: Ureteropelvic junction obstruction: which surgical approach? Eur Urol Suppl 2009; 8: 778–781.
14.
Yin Z, Wei YB, Liang BL, Zhou KQ, Gao YL, Yan B, Wang Z, Yang JR: Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction. Urolithiasis 2015; 43: 255–260.
15.
Chen Z, Zhou P, Yang ZQ, Li Y, Luo YC, He Y, Li NN, Xie CQ, Lai C, Fang XL, Chen X: Transperitoneal mini-laparoscopic pyeloplasty and concomitant ureteroscopy-assisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones. PloS One 2013; 8:e55026.
16.
Stravodimos KG, Giannakopoulos S, Tyritzis SI, Alevizopoulos A, Papadoukakis S, Touloupidis S, Constantinides CA: Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature. Res Rep Urol 2014; 6: 43–50.
17.
Yang K, Yao L, Li X, Zhang C, Wang T, Zhang L, Fang D, He Z, Zhou L: A modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction. Urology 2015; 85: 263–267.
18.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004; 240: 205–213.
19.
Scardino PT, Scardino P: Obstruction at the ureteropelvic junction; in Bergman H (ed): The Ureter. New York, Springer, 1981,pp 697–716.
20.
Meretyk I, Meretyk S, Clayman RV: Endopyelotomy: comparison of ureteroscopic retrograde and antegrade percutaneous techniques. J Urol 1992; 148: 775–782.
21.
Knudsen BE, Cook AJ, Watterson JD, Beiko DT, Nott L, Razvi H, Denstedt JD: Percutaneous antegrade endopyelotomy: long-term results from one institution. Urology 2004; 63: 230–234.
22.
Minervini A, Davenport K, Keeley FX Jr, Timoney AG: Antegrade versus retrograde endopyelotomy for pelvi-ureteric junction (PUJ) obstruction. Eur Urol 2006; 49: 536–542.
23.
Samarasekera D, Chew BH: Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction. Can Urol Assoc J 2011; 5: 134–136.
24.
Dimarco DS, Gettman MT, McGee SM, Chow GK, Leroy AJ, Slezak J, Patterson DE, Segura JW: Long-term success of antegrade endopyelotomy compared with pyeloplasty at a single institution. J Endourol 2006; 20: 707–712.
25.
Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM: Laparoscopic dismembered pyeloplasty. J Urol 1993; 150: 1795–1799.
26.
Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR: Laparoscopic pyeloplasty: the first 100 cases. J Urol 2002; 167: 1253–1256.
27.
Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG: Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 2006; 67: 932–936.
28.
Rassweiler JJ, Subotic S, Feist-Schwenk M, Sugiono M, Schulze M, Teber D, Frede T: Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty. J Urol 2007; 177: 1000–1005.
29.
Kouriefs C, Georgiades F, Grange P: Stones first! a gas pyelo-nephroscopy strategy for laparoscopic pyeloplasty and renal stone extraction. Urology 2017; 109: 206–209.
30.
Link RE, Bhayani SB, Kavoussi LR: A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 2006; 243: 486–491.
31.
Hong P, Ding G, Zhu D, Yang K, Pan J, Li X, Chen Z, Zhang L, Tang Q, Hao H, Zhou Z, Zhou L: Head-to-head comparison of modified laparoscopic pyeloplasty and robot-assisted pyeloplasty for ureteropelvic junction obstruction in China. Urol Int 2018; 101: 337–344.
32.
Li XD, Wu YP, Wei Y, Chen SH, Zheng QS, Cai H, Xue XY, Xu N: Predictors of recoverability of renal function after pyeloplasty in adults with ureteropelvic junction obstruction. Urol Int 2018; 100: 209–215.
© 2019 S. Karger AG, Basel
2019
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