Category: Laparoscopic/ Robotic: Other
Introduction & Objective : Xanthogranulomatous pyelonephritis (XGPN) is considered a relative contraindication to laparoscopic nephrectomy (LN), due to the potential surgical difficulty. The objective of this paper is to identify preoperative predictors of surgical difficulty or conversion from laparoscopic to open approach in XGPN based on clinical, laboratory and tomography (CT) parameters.
Methods : The charts of 320 patients that underwent transperitoneal laparoscopic nephrectomy for benign conditions from 2006 to 2015 were retrospectively reviewed. Twenty-three patients (7,18%) had a confirmative histopathological diagnosis of XGPN and were further analyzed. Data regarding age, sex, operative time, bleeding, hospital stay, radiological data, conversion to open surgery and complications were evaluated.
Results : Operative time was longer in cases of staghorn stone and in cases of conversion to open surgery (p <0,0001). The bleeding rate was also longer in the presence of staghorn stone (p: 0,006), in patients with conversion to open approach (p: <0,0001) and for the patients who developed any grade of complication (p: 0,03). There was statistically significant difference between the distribution of hematuria and length of hospital stay between the patients that had a conversion to open approach (p<0,001).
The laparoscopic treatment of XGPN remains challenging and controversial, due to the technical difficulties posed by the inherent inflammatory process. The presence of staghorn stone is related with higher surgical difficulty based on longer operative time, lengtht of hospital stay, bleeding rate and risk of complications. These data may help novice surgeons to make a better selection of the patients and the surgical approach, while obtaining the surgical proficiency curve.
Ana Cardenas-Ortiz– Urologist, Universidad del Rosario, Colombia, Bogota , Distrito Capital de Bogota, Colombia
Paulo Kawano– , Botucatu, Sao Paulo, Brazil
Rodrigo Guerra– , Botucatu, Sao Paulo, Brazil
Hamilto Yamamoto– , Botucatu, Sao Paulo, Brazil
Joao Amaro– , Botucatu, Sao Paulo, Brazil
Americo Sakai– , Sao Paulo, Sao Paulo, Brazil
Horacio Consolmagno– , Sao Paulo, Sao Paulo, Brazil
Marcos Nogueira– , Sao Paulo, Sao Paulo, Brazil
Oscar Fugita– Universidade Estadual Paulista, Sao Paulo, Sao Paulo, Brazil
Universidad del Rosario, Colombia
Bogota , Distrito Capital de Bogota, Colombia
Urologist from Universidad del Rosario Bogotá colombia
Endourology fellowship from American urologic associaton , Hospital Estadial paulista Sao Paulo Brasil
Member of Endourological Society
Member of Colombian Society of Endourology
Specialist on Universitary teaching from Universidad del Bosque, Bogota Colombia