Login to Access Video or Poster Abstract: MP23-10
Sources of Funding: None

Introduction

Xanthrogranulomatous pyelonephritis (XGP) has historically been managed with open nephrectomy. In the era of minimally invasive surgery, a small number of reports have evaluated the use of a laparoscopic approach in XGP, with variable results. We evaluated our experience with XGP over the last 15 years. This represents the largest series to date of laparoscopic nephrectomy for XGP.

Methods

Retrospective review of all nephrectomy and partial nephrectomy specimens from May 2001 to August 2016 disclosed 31 patients with pathologically confirmed XGP. 28 patients underwent total nephrectomy (18 laparoscopic, 1 robotic, 9 open) and 3 patients underwent partial nephrectomy (2 robotic, 1 open). Conversion to open was performed in 3 of the laparoscopic cases. The probability of undergoing laparoscopic nephrectomy significantly increased over time (p=0.063).

Results

There were no differences in overall complication rate (38.9% vs. 53.8%, p=0.48), Clavien I and II complications (22.2% vs. 30.8%, p=0.689), Clavien III and IV complications (16.7% vs. 23.1%, p=0.67), readmissions (22.2% vs. 23.1%, p=1.0), or mean operative time (191 vs 209, p=0.31). Blood loss (350 vs. 775, p= 0.009) and intraoperative transfusion rate (11.1% vs. 53.8%, p =0.017) were significantly higher in the open group. There were no perioperative mortalities in either group. The mean hospital length of stay was 8 days for the open group and 3.2 in the laparoscopic group (p<0.001). Median follow-up was 47 days. Patients with preoperative glomerular filtration rate of <60, blood loss >1 liter, or hospital stay >9 days were more likely to suffer a major complication or require readmission.

Conclusions

Although early reported experience with laparoscopic nephrectomy for XGP was not favorable, our larger and more contemporary series demonstrates it can be performed safely, with less blood loss and shorter hospital stays. Complication rates and readmission rates are high regardless of approach.

Funding

None