Objective To study the key points and preliminary experience in the application of laparoscopic pelvilithotomy combined with percutaneous nephrolithotomy(PCNL)surgery in multiple renal calculi. Methods Eight patients,accepted laparoscopic pelvilithotomy combined with PCNL surgery in our hospital from January 2008to December 2009,were enrolled into the study. Retroperitoneal approach were performed in all operations. The biggest stone was 3.3 cm ×2.3 cm,the smallest one was 0.5 cm ×0.5 cm. All patients had renal pelvis cast stone along with multiple small renal calyceal stones. The stones were removed under laparoscopic operation at the first step. If it was difficult to remove the pelvis cast stone,nephroscope were settled into the pelvis through incision,and then the shattered stone smashed by lithotripsy were removed under the observation of nephroscope. Further exploration and removal of the remaining stones in every calices was necessary for the patients. Results The operations were successful in all cases and all stones were removed thoroughly and get satisfactory effects. The average operation time was 90 minutes. No serious complications happened,such as bleeding,urine leakage or ureteral stricture. The average length of hospital stay was 5 days. Conclusions Our treatment combines the advantages of both laparoscopic pelvilithotomy and percutaneous nephrolithotomy to reduce the incidence of complications and improve the therapeutic effects.

Objective To investigate the feasibility, safety and clinical efficacy of staged endo-scopic treatment for refractory ureteral calculus. Methods Eighteen refractory ureteral calculus ea-ses (11 males and 7 females) treated with staged endoscopic treatment were retrospectively analyzed. The mean age of the patients was 32 years (range 2-65 years). Of the 18 cases, 2 had bilateral ure-teral calculi. Of the 20 ureteral calculi, 11 were in the upper, 6 were in the middle and 3 in the lower part of ureter. The mean diameter of the calculi was 0.9 cm (range 0.4-1.6 cm). Staged endoscopic treatment was offered to patients because of failure of ureterscopic lithotripsy or extracoporeal shock-wave lithotrispy caused by uretreal twist or eongential narrow. For all the cases, it was hard to com-pletely clear all the stone load and ureteral stents or percutaneous nephrostomy were performed to drain the kidney in the first session. Then, the calculi were removed by endoscopic manipulations in the second or third session. Results Thirteen patient's calculi were completely cleared in the second sessions 40-50 d after the first operation. The other 5 cases had to accept the third session 50-60 d after the second operations. There was no intra- or post-operative complication in all cases. During the 6 months' follow-up, there was no sign of recurrence. Conclusion Staged endoscopic treatment is a feasible and safe method and has high efficiency in the management of refractory ureteral calculi.