Introduction. Percutaneous nephrolithotripsy (PNL) is considered as the main treatment method of patients with large and staghorn kidney stones. In some cases, laparoscopic pyelolithotomy (LP) may be an alternative option to PNL. The aim of our work was to compare the results of these surgical methods for treatment of large pelvis stones.
Materials and methods. The results of surgical treatment of 60 patients with large pelvis stones were reviewed. In 40 patients (66.7%) PNL were performed, while in 20 cases (33.3%) LP were done. In the PNL group, the average stone size was 2.7 (2.5–3.8) cm and in the LP group it was 3.0 (2.6–4.2) cm. Four patients in the LP group had kidney malrotation, one patient had pelvic dystopia, and in another case a horseshoe kidney was diagnosed. The operative time and stone-free rate, intra- and postoperative complications, the amount of blood loss and the length of hospitalization were compared.
Results. There was no conversion in both groups. There were no significant differences in the mean length of hospitalization (4.5±1.5 vs 4.4±1.4 days) and analgesic use (2.2±0.9 vs 2.4±1.0 days) and stone-free rate (100 vs 90%) between groups. The mean operative time was significantly higher at the PL (110.0±25.0 vs 65.4±24.5 min; p≤0.05), but the amount of blood loss was significantly lower (70±28 versus 160.0±55 ml; p≤0.05) compared to the PNL group.
Conclusions. PNL remains the main treatment method for patients with large kidney stones. However, abnormal kidneys, concomitant ureteropelvic junction obstruction or endoscopic treatment failure can be indications to LP.

Keywords: urinary stone disease, pyelolithotomy, percutaneous nephrolithotomy, laparoscopy, kidney stones, surgical treatment