Laparoscopic-assisted percutaneous nephrolithotomy for pelvic kidney stones

Introduction: Ectopic kidneys, including those situated in the pelvic region, are at a higher risk of nephrolithiasis, specially due to impaired drainage of the pyelocaliceal system. Performing percutaneous procedures on pelvic kidneys presents unique challenges as they are encased by pelvic bones in the posterior region and surrounded by intestines anteriorly. Case Report: Between December 2014 and January 2016, we successfully managed three patients with pelvic kidney stones using laparoscopic-assisted percutaneous nephrolithotomy (PCNL). Among them, two patients had a history of previous open stone surgery (OSS) on the same kidney. The surgical procedure was performed in the supine (Trendelenburg) position under general anesthesia after placing a ureteral catheter. In one patient with no prior surgical history, laparoscopic dissections were unnecessary, since safe access to the pyelocaliceal system was achieved by retracting the bowel with a grasper. Following contrast injection via the ureteral catheter, fluoroscopic control facilitated percutaneous access to the pelvic kidneys. A double-J (DJ) stent was placed at the end of operation. Conclusion: All patients achieved stone-free status with minimal bleeding (mean hemoglobin drop was 0.5 g/dL) or urine leakage. No major or minor complications occurred, and all patients were discharged on the second-day post-surgery. Laparoscopic-assisted PCNL proves to be a safe and effective surgical option for treating pelvic kidney stones. Its success in managing pelvic kidney stones adds to its value as a available treatment option for patients having this condition.