Laparoscopic nephrectomy for Xanthogranulomatous Pyelonephritis: First surgical outcomes report from Pakistan

Objectives: The aim of this study was to analyze the perioperative and postoperative outcomes of laparoscopic nephrectomy (LN) in the management of patients with xanthogranulomatous pyelonephritis (XGPN). Methodology: This retrospective review examined medical records of patients who underwent LN for histopathologically confirmed XGPN at the Aga Khan University Hospital, Pakistan, from January 2019 to October 2024. Patient demographics, clinical presentation, microbiological findings, imaging results, operative details, and postoperative outcomes including hospital stay, complications, and 30-day readmission were evaluated. Results: A total of 13 LNs were performed for XGPN. The mean patient age was 49.6 ± 17.3 years, with females accounting for 61.5% of cases. Flank pain was the most common presenting symptom, while hypertension and diabetes mellitus were the most frequent comorbidities (23.1% each). Most preoperative urine cultures were negative; among positive cultures, Escherichia coli was the predominant pathogen. Urinary tract stones were present in 84.6% of patients. Preoperative percutaneous nephrostomy was performed in majority (61.5 %). Renal scans in all patients revealed markedly impaired renal function. LN was completed successfully in all cases without conversion to open surgery. The mean operative time was 194 + 49 minutes, with minimal blood loss and an average hospital stay of three days. Postoperative complications occurred in two patients (15.4%), and no patient required readmission within 30 days. Survival was 100% among those with at least one year of follow-up. Conclusion: Laparoscopic nephrectomy is a feasible, safe, and effective treatment option for XGPN in our setting and is associated with favorable surgical outcomes.