Pyelolithotomy With Concomitant Pyeloplasty

It is not uncommon to find coexisting secondary renal stones as a sequela of uretero pelvic junction obstruction. In such cases, the pyelotomy incision should be performed very carefully because it will eventually be incorporated in the flaps reconfigured for laparoscopic pyeloplasty (13,19). The line of incision in the pelvis can be marked and the pelvis incised with endoscissors. The pelvis is not disconnected from the ureter until all stones are cleared and the ureter is spatulated. Care should be taken if there is a priorly placed stent, so that the stent is not damaged or dislodged.

Occasionally, stone removal with rigid laparoscopic instruments becomes difficult and in such a situation, a flexible nephroscope, cystoscope, or ureteroscope can be used to retrieve caliceal stones.

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