A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention -is there a role for open surgery?Sir,We read with interest this paper [1] but we were surprised that the role of laparoscopic ureterolithotomy was not explored. We have not undertaken open ureterolithotomy at King's College Hospital for the last 3 years. The laparoscopic approach is safe and successful, with a faster recovery time [2,3]. We would value the authors' view on this approach. ReplyWe appreciate the comments by Choi et al.; indeed, the lack of reference to laparoscopic ureterolithotomy in our paper is predominantly because we have little experience with this method. Although laparoscopic ureterolithotomy causes relatively less morbidity than open surgery, it still requires an inpatient stay, a drain left in situ and an operative duration of >60 min, like open surgery. Additionally, leaving a ureteric stent is highly recommended when the ureterotomy is not sutured, and even when the ureterotomy is closed. This would require an additional procedure for removing the stent if left longer with no pull-through thread. The limited experience with this method is another restriction, probably because in this advanced era of endourology, the numbers of patients suitable for laparoscopic ureterolithotomy are limited, as shown by most reported series, which include few (10-25) patients. Currently, we and most others in contemporary urological practice regard ureteroscopy and ESWL as the first-line treatments for managing ureteric stones, and the exact role of laparoscopic ureterolithotomy remains poorly defined. Open surgery similarly has limited indications, but this is a time-tested method that could be used as a salvage procedure after the failure of endourological methods, and rarely as a primary management, when informed patients so desire or wish to avoid multiple endourological procedures.

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