Laparoscopic ureterolithotomy, flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy for treatment of uppe
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ORIGINAL ARTICLE
Laparoscopic ureterolithotomy, flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy for treatment of upper urinary calculi in patients with autosomal dominant polycystic kidney disease Yuchen Xu1,2,3,4 · Zhengming Bai1,2,3,4 · Dongyue Ma2,3,4 · Qingsong Niu2,3,4 · Binbin Gong1,2,3 · Jun Zhou1,2,3 · Jianzhong Wang1,2,3 · Zongyao Hao1,2,3 · Chaozhao Liang1,2,3,4 Received: 25 November 2019 / Accepted: 19 March 2020 © Japanese Society of Nephrology 2020
Abstract Objectives Patients with autosomal dominant polycystic kidney disease (ADPKD) showed relatively high incidence of urinary stones. Enlarged kidneys occupied by cysts could make the stone-removal surgery relatively difficult. This study aimed to compare the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU), flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) in the ADPKD patients with upper urinary stones. Methods In this study, 45 patients with ADPKD who underwent RPLU, FURL and PCNL procedures were evaluated. Demographic and serum parameters, stone features, outcomes and complications were analyzed. Results 45 patients were included in the present study, 13 received RPLU, 21 received FURL, and 11 received PCNL. There were no significant differences in demographic and serum parameters between the three groups. Stone-free rates of the three approaches are 100%, 85.7% and 90.9%, respectively. Patients who underwent FURL had shorter mean operative time and postoperative hospital stay. Compared to RPLU and PCNL, FURL resulted in fewer complications, but the difference is statistically non-significant. Conclusions RPLU, FURL and PCNL are commonly used surgical methods to solve upper urinary calculi in ADPKD patients and could achieve satisfactory stone clearance. Among them, FURL showed a relative high safety and faster recovery. Keywords ADPKD · Urolithiasis · Lithotomy
Introduction Yuchen Xu and Zhengming Bai have contributed equally to this work. * Zongyao Hao [email protected] * Chaozhao Liang [email protected] Yuchen Xu [email protected] Zhengming Bai [email protected] 1
Department of Urology, the First Affiliated Hospital of Anhui Medical University, Jixi Road #218, Hefei, Anhui 230022, P.R. China
2
Institute of Urology, Anhui Medical University, Hefei, China
3
Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
4
Anhui Province PKD Center, Hefei, China
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited renal diseases, accounting for 8–10% of dialysis and renal transplant patients [1]. The development of renal cysts can crush and destroy kidney parenchyma, resulting in renal function impairment and eventually end-stage renal disease (ESRD) [2]. Due to abnormalities in anatomical structure and metabolic changes, the prevalence of kidney stones in ADPKD patients is 5–10 times that of the normal population [3, 4]. Nearly 8–36% of the patients have stone symptom
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