Percutaneous nephrolithotomy for XXXX : over, around, or through.

@entity1 @entity8
OBJECTIVES: The treatment of @entity1 with complex urolithiasis in @entity8 can be challenging. Because the location of an @entity8 can vary, each case requires a unique and, at times, unconventional approach. We reviewed the techniques we have developed to treat such @entity1 , including laparoscopic-assisted tubeless, transhepatic, and transiliac percutaneous nephrolithotomy (PNL). METHODS: We performed a retrospective analysis of all @entity1 with @entity8 who underwent PNL at our institution. Six @entity1 underwent laparoscopic-assisted PNL, one underwent transiliac PNL, and one underwent transhepatic PNL. All laparoscopic-assisted procedures were performed tubeless, with an internalized ureteral stent placed at the conclusion of the procedure. RESULTS: All @entity1 underwent successful PNL. On computed tomography, performed on the morning of postoperative day 1, all @entity1 who underwent laparoscopic-assisted PNL were stone free. The @entity1 who underwent transiliac PNL and transhepatic PNL required secondary procedures to attain a stone-free status. The mean length of hospitalization was 3 days for the laparoscopic-assisted cohort, 1 day for the transhepatic @entity1 , and 3 days for the transiliac @entity1 . CONCLUSIONS: For the @entity1 with a large or complex stone burden in an @entity8 , laparoscopic-assisted PNL is the optimal treatment. Performing such a procedure tubeless may be associated with a reduced hospital stay. For those @entity1 with a hostile peritoneal cavity owing to prior surgical exploration, consideration should be given to a more individualized approach.
