Retroperitoneoscopic nephrectomy for pyonephrotic nonfunctioning kidney.

OBJECTIVES: To review the feasibility and outcome of retroperitoneoscopic nephrectomy (RPN) for pyonephrotic nonfunctioning kidneys.

METHODS: RPN for pyonephrotic nonfunctioning kidneys was used in 52 patients from July 2001 to May 2007. Percutaneous nephrostomy drainage was instituted in 46 patients because of sepsis before being referred to our institute. However, the remaining 6 patients underwent RPN without previous diversion. The mean patient age was 46.4 years (range 22-72). The etiology was stone disease in 29 patients, ureteropelvic junction obstruction in 18, and genitourinary tuberculosis in 5; 32 patients had diabetes mellitus as a comorbid condition.

RESULTS: RPN was performed successfully in 46 patients (88.5%); 6 patients required conversion to open surgery (1 emergently because of colonic injury and 5 electively because of nonprogression of the procedure). In 6 patients, subcapsular nephrectomy was required. The mean operating time was 110 minutes (range 90-180). The mean blood loss was 95 mL (range 80-300), and the mean analgesic requirement was 150 mg (range 50-400) of tramadol. Five patients had Clavien grade I, 7 had grade II, and 2 had grade IIIb complications. One patient required blood transfusion. The mean hospital stay was 3.6 days (range 2-8), and the mean return to normal activity was 14.2 days (range 11-21).

CONCLUSIONS: RPN, although challenging, is safe, reliable, and successful for treatment of pyonephrotic nonfunctioning kidneys.