Stones First! a Gas Pyelo-Nephroscopy Strategy for Laparoscopic Pyeloplasty and Renal Stone Extraction

Objective To report our experience on gas endoscopy as the first step of pelvi-ureteric junction (PUJ) obstruction repair when complicated by nephrolithiasis. Materials and Methods Stone formation because of urine stasis is a known complication of PUJ obstruction and an indication for its surgical repair. The undisputed results of the Anderson-Hynes dismembered pyeloplasty make it a quasi-gold standard; however, the identification and extraction of calyceal stones through the laparoscopic route can be challenging. Between 2009 and 2016, 39 patients underwent laparoscopic pyeloplasty at Ygia Polyclinic, with a subgroup of 6 patients having concomitant calyceal stones. These 6 patients first underwent gas pyelo-nephroscopy before dismembering the PUJ. Demographic data, intraoperative technical details, outcomes, as well as postoperative outcomes, were collected and analyzed. Results We report a small series (n = 6) with 3 minor modifications of the laparoscopic repair of PUJ obstruction complicated by stones. One modification is to carry out a pyelo-nephroscopy for stone extraction before dismembering the junction. The second modification is the use of gas medium to distend the renal cavity, and the third is the use of a flexible cystoscope. Postoperative recovery was uncomplicated in all 6 patients, with successful relief of the PUJ obstruction and stable stone free results demonstrated on follow-up for all patients. Conclusion We claim that these modifications overcome the usual challenges related to working in a collapsed cavity and using fluid media, while achieving desirable outcomes.