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
Processing time: 157 Days and 10.6 Hours
ARTICLE HIGHLIGHTS
Research background

Horseshoe kidney (HK) with renal stones is challenging for urologists. No studies have investigated the best surgical approach for HK with a limited number of 20-40 mm renal stones, which is commonly found.

Research motivation

Laparoscopic treatment was reported in some case reports; however, the therapeutic outcome of the retroperitoneal compared with the transperitoneal approach is unknown. The possible therapeutic differences between these two approaches was worthy of study.

Research objectives

This study aimed to investigate the clinical characteristics and outcomes of patients with HK and renal stones, who underwent retroperitoneal or transperitoneal laparoscopic treatment.

Research methods

We performed a retrospective study of 12 patients treated with retroperitoneal or transperitoneal laparoscopy for HK and a limited number of 20-40 mm renal stones. The baseline characteristics and postoperative outcomes of these patients were summarized and analyzed. Statistical analyses were performed with SPSS Statistics v. 22.0.

Research results

The mean postoperative fasting time of patients in the retroperitoneal group was shorter than that in the transperitoneal group. There was no significant difference in operation time, estimated blood loss and length of hospital stay between the retroperitoneal group and transperitoneal group. All patients in both groups achieved a complete stone-free rate and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate from the preoperative stage to postoperative day 1 and 3-mo in the retroperitoneal group and transperitoneal group was not statistically significant.

Research conclusions

Both retroperitoneal and transperitoneal laparoscopic lithotripsy are safe and effective surgical approaches for HK patients with a limited number (n ≤ 3) of 20-40 mm renal stones. Laparoscopic lithotripsy is an effective clinical alternative to percutaneous nephrolithotomy and flexible ureteroscopy.

Research perspectives

More attention should be paid to the treatment of HK patients with a limited number of medium-sized renal stones. The ideal choice of retroperitoneal or transperitoneal laparoscopy should be patient-individualized and further elucidated by more prospective clinical trials.