Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4753-4762
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4753
Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys
Xin Chen, Yi Wang, Liang Gao, Jin Song, Jin-You Wang, Deng-Dian Wang, Jia-Xing Ma, Zhi-Qiang Zhang, Liang-Kuan Bi, Dong-Dong Xie, De-Xin Yu
Xin Chen, Yi Wang, Jin Song, Jin-You Wang, Deng-Dian Wang, Jia-Xing Ma, Zhi-Qiang Zhang, Liang-Kuan Bi, Dong-Dong Xie, De-Xin Yu, Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
Liang Gao, Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
Author contributions: Chen X, Wang Y, Wang JY and Yu DX performed the surgery; Song J, Gao L, Bi LK and Xie DD completed the figure illustration; Wang DD, Ma JX and Zhang ZQ finished the statistical analyses; all authors contributed to writing and revising this report; Chen X is the main author and Yu DX is the senior author; all authors issued final approval for the version to be submitted.
Supported by the National Natural Science Foundation of China, No. 81572507.
Institutional review board statement: The study was approved by the Ethics Committee of Anhui Medical University, Hefei, China and carried out in accordance with the Helsinki Declaration.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Not available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Xin Yu, MD, Chief Doctor, Surgeon, Department of Urology, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Hefei 230032, Anhui Province, China. yudx_urology@126.com
Received: May 21, 2020
Peer-review started: May 21, 2020
First decision: June 7, 2020
Revised: June 22, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: October 26, 2020
Abstract
BACKGROUND

Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.

AIM

To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.

METHODS

This was a retrospective study of 12 patients with HK and a limited number (n ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).

RESULTS

No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min vs 151.40 ± 39.54 min, P = 0.399), estimated blood loss (48.57 ± 31.85 mL vs 72.00 ± 41.47 mL, P = 0.292) and length of hospital stay (12.14 ± 2.61 d vs 12.40 ± 3.21 d, P = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m2), respectively (P = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m2), respectively (P = 0.581).

CONCLUSION

Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.

Keywords: Horseshoe kidney, Retroperitoneal, Transperitoneal, Laparoscopic lithotripsy, Renal stones

Core Tip: This was a retrospective study of 12 patients with horseshoe kidney (HK) and a limited number (n ≤ 3) of 20-40 mm renal stones treated by either retroperitoneal or transperitoneal laparoscopic lithotripsy. The mean postoperative fasting time of patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). All patients in both groups had a complete SFR and postoperative renal function was within the normal range. Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.