Laparoscopic Pyelolithotomy: The Optimal Drainage Method

Abstract The aim of the study was to improve the treatment results of patients by improving the urinary tract drainage methods during laparoscopic surgery. Introduction. Percutaneous renal drainage is effective for most, if not all, obstructions, including intrarenal, ureteropelvic or ureteral obstructions. An alternative to percutaneous drainage is drainage through a ureteral catheter or a retrograde stent. The choice of antegrade or retrograde drainage of the upper urinary tract collecting system depends on the indication, health status and anatomy of the patient, as well as the preferences of both the patient and the physician. Using percutaneous renal access, surgical removal of upper urinary tract stones, urothelial tumors, obstructions, and calyceal diverticula can be performed. Material and methods. 45 patients who underwent laparoscopic pyelolithotomy at the Republican Specialized Scientific and Practical Medical Center of Urology in the period from 2012 to 2022 were selected for the study. The mean age of the patients was 34.2 ± 13.3 years (M±δ). There were 30 (66.7%) males and 15 (33.3%) females among them. In 26 (57.8%) patients, the surgery was performed on the left side, and in the remaining 19 (42.2%) ones - on the right. Results. To assess the efficiency and safety of upper urinary tract drainage, the duration of surgical intervention; the amount of intraoperative blood loss; the frequency of intra- and postoperative complications; the frequency of additional interventions; the severity of pain syndrome; the duration of the patient's stay in the hospital; the length of the incision; assessment of the patient's quality of life using an adapted Wisconsin questionnaire (WISQOL) were comparatively analyzed. During the study, the duration of surgical intervention was analyzed to assess the impact of nephrostomy drainage period during laparoscopic pyelolithotomy, as well as the time to relieve intraoperative complications associated with the drainage method. Conclusion. The developed technique for installing nephrostomy drainage during laparoscopic pyelolithotomy allows to install drainage on upper urinary tracts during the surgery itself, without involving additional specialists and equipment. This technique is not only safe for use in patients, but also reduces the duration of surgery and the frequency of postoperative complications, allows patients to get rid of drains at an earlier date and contributes to a rapid improvement of the life quality.

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