AUA 2017: Laparoscopic Versus Open Nephrectomy For Xanthogranulomatous Pyelonephritis: A Contemporary Series

Boston, MA ( Xanthrogranulomatous pyelonephritis (XGP) has traditionally been managed with open nephrectomy. In this era of minimally invasive surgery, some reports have evaluated the use of a laparoscopic approach in XGP, with variable results. Dr. Benabdallah presents the experience of a single center managing a relatively large case series of XGP over the last 15 years.

A retrospective review of all nephrectomy and partial nephrectomy specimens from May 2001 to August 2016 within the authors’ institution identified 31 patients with pathologically confirmed XGP. 28/31 patients underwent total nephrectomy (18 laparoscopic with 3 conversions, 9 open, and 1 robotic) and 3/31 patients underwent partial nephrectomy (2 robotic, 1 open).The aim of the study was to compare open vs. laparoscopic nephrectomy for XGP.

With a median follow up time of 47 days, overall no significant differences were found in the complication rate (38.9% open vs. 53.8% laparoscopic, p=0.48) and mean operative time (191 vs 209, p=0.31). Additionally, there were no significant differences in the readmission rate with almost an equal rate of ~ 22%. Intraoperative transfusion rate and overall hospital stay were considerably lower in the laparoscopic modality (11.1% vs. 53.8%, p =0.017), and (3.2 vs. 8 days, p <0.001), respectively. Multivariate logistic regression analysis demonstrated that patients with preoperative glomerular filtration rate of <60 mL/min per 1.73 m², blood loss >1 liter, or hospital stay >9 days were more likely to suffer a major complication or require readmission.

Dr. Benabdallah summarized his presentation by stressing out the safety and feasibility of laparoscopic nephrectomy for XGP. The laparoscopic modality has considerably better overall results than the open modality for this indication, albeit complication and readmission rates are high regardless of modality.

Authors: Justin Benabdallah, St. Louis, MO

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA