Pyelolithotomy or Ureterolithotomy

Surgery Overview

The term pyelo means renal pelvis, and the term lithotomy means removal of stone. Since the advent of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephropyelolithotomy (PCN), pyelolithotomy is becoming an uncommon surgery in most developing countries. However, before these newer technologies, pyelolithotomy was the procedure of choice for stones within the renal pelvis, including stones that demonstrated minimal invasion into calyces and infundibulum. Pyelolithotomy differs from an anatrophic nephrolithotomy, as the anatrophic nephrolithotomy allows for greater access to calyces and allows for repair of infundibulum and calyces. Anatrophic nephrolithotomy is indicated for large multiple-branched staghorn calculi with infundibular stenosis.

ESWL is clearly noninvasive, but it may necessitate a cystoscopy and the insertion of a stent to drain the kidney or a nephrostomy in some cases involving infection. ESWL is associated with less morbidity than pyelolithotomy, but the overall failure rate and the amount of residual stone fragments are higher. Lower pole stones fragments do not flush out of the renal unit as readily as midpole and upper pole fragments.

PCN is a highly technical procedure and requires some experience for optimal results. At some facilities, these procedures require the teamwork of a radiologist and a urologist. Morbidity is higher than with ESWL, but residual stone fragments are less common. The stone-free rate associated with percutaneous nephrolithotomy (PNL) is 78%; ESWL, 54%.