Outcomes of the Surgical Stone Management in Pelvic Ectopic Kidneys: A Retrospective Comparison of Three Different Approaches

<b>Background/Objectives</b>: This study evaluates and compares the surgical outcomes of open pyelolithotomy, laparoscopic pyelolithotomy, and retrograde intrarenal surgery (RIRS) in the management of pelvic ectopic kidney stones. <b>Methods</b>: A retrospective analysis was conducted on 47 adult patients with pelvic ectopic kidney stones who underwent surgery between January 2009 and January 2024. Patients were categorized as open pyelolithotomy (n = 15), laparoscopic pyelolithotomy (n = 14), or RIRS (n = 18). Stone-free (SF) rates were assessed in the early postoperative period (1st or 2nd day), in the 1st month, and in the 3rd month. Demographic data, stone characteristics, operative data, and complications were recorded. <b>Results</b>: RIRS had significantly shorter operative and hospitalization times but a lower SF rate in the 3rd month (44.4%) compared to laparoscopy (92.9%) and open pyelolithotomy (86.7%). Additional procedures were required in 50% of RIRS cases to achieve SF status, while none were needed in the other groups. Complications included three Grade 2 cases (two bleeding; transient creatinine elevation) in open pyelolithotomy, two Grade 2 (urinary leakage; infection) and two Grade 3 cases (conversion to open surgery; trapped stent removal) in laparoscopic pyelolithotomy, and one Grade 2 case (febrile infection) in RIRS. <b>Conclusions</b>: Laparoscopic pyelolithotomy demonstrated the highest efficacy and comparable complication rates; making it the preferred approach for pelvic ectopic kidney stones. Open pyelolithotomy remains a valuable alternative where laparoscopic expertise or resources are limited. Although less invasive, RIRS showed lower efficacy due to the challenging anatomy of pelvic ectopic kidneys.