Laparoscopic partial nephrectomy for tumour in the presence of nephrolithiasis or pelvi-ureteric junction obstruction.

Objective: To report on patients with a small renal mass and concomitant calculus or pelvi-ureteric junction obstruction (PUJO), and to propose an algorithm for minimally invasive management when these conditions coexist, as the success of laparoscopic partial nephrectomy (LPN) depends greatly on the absence after surgery of ureteric obstruction.

Patients And Methods: Fifteen (3%) of 548 patients undergoing LPN (November 1999 to May 2005) had concomitant calculus/PUJO; the calculus/PUJO was treated in six, either before (one), during (three) or after (two) LPN, depending on the presence of obstruction. The remaining nine patients were monitored as they had a punctate and unobstructing stone burden. RESULTS; The mean (range) tumour size was 2.7 (1.4-4) cm, the operative duration 3.8 (2-6) h, the warm ischaemia time 34.8 (22-53) min, and blood loss 237 (50-600) mL. Two patients with concomitant PUJO had a single-session dismembered Anderson-Hynes pyeloplasty and LPN. Three patients with smaller stones (5-12 mm) had extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy or or ureteroscopic removal before (one) or after (two) LPN. One patient with a larger 1.6 cm obstructing renal pelvic calculus had laparoscopic flexible pyeloscopy, but the stone was not visualized. At the end of all treatments, the 6-month tumour-free and stone-free rates were 15/15 and 11/13, respectively.

Conclusion: Patients with a concomitant small renal mass and calculus/PUJO can be successfully managed in a simultaneous or staged manner using minimally invasive techniques. A management algorithm is presented.