Objective To present the complications from our first staghorn calculi, polycystic kidney disease, and xanthogranulomatous pyelonephritis. While there was no 100 cases of laparoscopic nephrectomy, a technically demanding procedure requiring lengthy experience, discernible decline in the decrease in complications with experience, operative duration decreased from a and to define the risk factors. Patients and methods Indications for laparoscopic nephmean of 204 min for the first 20 cases to 108 min for the last 20. Complications and conversions were more rectomy included patients requiring nephrectomy for benign pathology and those requiring nephroureterecclosely associated with diagnosis than with the surgeon's experience. tomy for upper tract transitional cell carcinoma confined to the upper ureter and/or renal pelvis. AllConclusion Laparoscopic nephrectomy and nephroureterectomy can be undertaken for a variety of indications patients were operated on by one surgeon (D.A.T.) via a transperitoneal route and data on diagnosis, outwith reasonable complication and conversion rates. Although inflammatory conditions increase the diBcome and complications collected prospectively. Results The overall complication rate was 18%, of which culty of these procedures, we feel that patients requiring nephrectomy for benign disease should be oCered 3% were major and 15% minor complications. Five cases were converted to open surgery electively. a trial of laparoscopic surgery. Keywords Laparoscopy, nephrectomy, complications Complications and conversions were associated with a history of pyonephrosis, previous renal surgery, Several risk factors have been associated with compli-

Objective  To review our experience with laparoscopic ureterolithotomy. Patients and methods  Since 1993, we have performed laparoscopic ureterolithotomy in 14 patients with ureteric stones. Laparoscopy was carried out in nine patients as a salvage procedure after failed ureteroscopy (six), shock wave lithotripsy (two), or both (one), and in five patients as a primary procedure for large stones (mean 27.2 mm, range 18–40). Patients in the former group had already undergone a mean of 1.88 procedures (range 1–4). Laparoscopic ureterolithotomy was carried out via a transperitoneal approach. Associated ureteric strictures were incised at the time of ureterotomy. Results  All procedures were completed laparoscopically and all patients were rendered stone‐free after a single procedure. The mean operative duration was 105 min. Ureteric strictures were incised in three patients, in two of whom dilatation was subsequently required; all three had a successful result. There were three minor complications. Conclusions  Laparoscopic ureterolithotomy can be a safe and effective procedure; it should be considered as a primary procedure for large mid‐ and upper ureteric stones.

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Objective To investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high‐energy magnetic fields to propel an impactor to fragment calculi. Patients and methods The records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi‐rigid ureteroscope, through which a 3 F EKL probe was passed. Results A total of 148 stones (mean stone size 11.5 mm, range 6–40) in 121 patients were treated using the EKL. One patient was lost to follow‐up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed‐dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone‐free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock‐wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent. Conclusion EKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi‐rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of ≥4 mm after EKL.