Laparoscopic simultaneous treatment of peripelvic renal cysts and stones: case series.

Introduction: Renal multiple peripelvic cysts are often symptomatic. Obstruction of renal hilum and the collecting system leads to hydronephrosis and could promote formation of stones. Managing both entities at the same time needs a new approach to minimize complications and improve success rates. We report for the first time five cases of symptomatic multiple peripelvic cysts and concomitant kidney stones treated by a laparoscopic approach.

Patients And Methods: Between 2003 and 2007 three men and two women, with a median age of 60 years with peripelvic renal cyst and synchronous kidney stones underwent a laparoscopic ablation of cysts, concomitant pyelolithotomy, and stone removal with a flexible auxiliary cystoscope. Mean cyst size was 45 mm (range 15-70 mm). Mean stone size was 25 mm (range 10-33 mm).

Results: The mean operative time was 173 minutes (range 150-235 minutes). There were neither intraoperative complications nor conversions to open surgery. Mean blood lost was less than 100 mL, and mean hospital stay was 3.2 days (range 3-5 days). After removal of ureteral catheter, patients were asymptomatic and without signs of hydronephrosis. Computed tomography after 6 months showed clearance of all cysts and stones without sign of recurrence.

Discussion: Laparoscopic management of urolithiasis should be an alternative choice of treatment in some particular and selected indication. Concomitant symptomatic peripelvic cysts and kidney stones could justify simultaneous laparoscopic management. The procedure is technically challenging but safe and effective, and it avoids a staged treatment.