Experience and Learning Curve of Retroperitoneal Laparoscopic Ureterolithotomy for Upper Ureteral Calculi

Fan, Tianyong; Xian, Peng; Yang, Lu; Liu, Yong; Wang, Qiang; Li, Hong

doi:10.1089/end.2008.0536

Cited by 26 publications

(13 citation statements)

References 17 publications

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“…Although stone-free rates with laparoscopic ureterolithotomy were higher, laparoscopic ureterolithotomy should not be considered a firstline treatment because recovery time is longer, complication rates higher and the procedure more invasive compared to SWL and UL. [22][23][24] Laparoscopic ureterolithotomy may be an alternative to open surgery in patients with failed endourological interventions and SWL.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Bozkurt

Yonguç

Arslan

et al. 2015

CUAJ

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Introduction:The management of patients with large impacted upper ureteral stones is difficult; there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones. Methods: In total, 86 patients with large impacted upper ureteral stones were included in this study. Of these patients 41 underwent UL and 45 underwent PCNL. The inclusion criteria were: longest diameter of stone ≥1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. Results: In the UL group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema despite balloon dilation. Of these 3 patients, we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injury following balloon dilation. The stricture was too firm and could not be passed in the third patient. Also in the UL group, 15 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones <1 cm and stones were successfully removed in all patients. No statistically significant difference was found between groups in terms of operation time. Mean hospital stay was significantly shorter in the UL group. Success rates were 82.3% in the UL group and 97.6% in the PCNL group (p = 0.001). Conclusion:The recent study confirms that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with large, impacted upper ureteral stones.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Bozkurt

Yonguç

Arslan

et al. 2015

CUAJ

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“…Al-Hunayan et al [21] in their series, found that the retroperitoneal approach is better in aspects related to the speed of postoperative recovery and oral intake because there is no bowel manipulation that minimized the incidence of bowel injury or postoperative ileus. Additionally, Fan et al [4] reported that the retroperitoneal approach decreases the incidence of ileus and intestinal adhesion and that even if urine leakage occurs, it can be confined to the retroperitoneal space and easily drained to avoid peritoneal contamination. [17,22] In contrast to the previously mentioned studies, Nambirajan et al [23] conducted a prospective randomized study in a more complicated procedure as they compared transperitoneal and retroperitoneal laparoscopic nephrectomy and concluded that there was no difference between the two approaches regarding the technical difficulty of the procedure or patient morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Recently, with the adoption of laparoscopy by most urologists, nearly all urological operations have been reported to be performed laparoscopically, including ureterolithotomy. [4] Focus on laparoscopic ureterolithotomy has increased since the initial report of laparoscopic retroperitoneal ureterolithotomy (LRU) by Wickham [5] in 1979, but the approach did not gain popularity until Gaur et al [6] described hydraulic balloon dilation that provides quick access to the retroperitoneum. Laparoscopic transperitoneal ureterolithotomy (LTU) was described for the first time by Raboy et al [7] in 1992.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

Khalil¹,

Omar²,

Abdel-baky³

et al. 2015

Turkish Journal of Urology

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Objective: This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. Material and methods:A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.Results: There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p= 0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Conclusion:Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.

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“…The operative time was 133 minutes in the global average, not statistically different between groups (a = 130 min, 2 = 136 min). Bove et al 26 and Fan et al 27 published similar operation time in their series. Both point out that the reduced space in the retroperitoneum and lack of experience in early cases substantially contribute to the prolongation of the operation, and that the gain of skill and experience provide a reduction in operative time.…”

Section: Results Results Results Resultsmentioning

confidence: 58%

O emprego do cateter duplo J diminui as complicações na ureterolitotomia retroperitoneoscópica

Cavalli

Filho

Slongo

et al. 2012

Rev. Col. Bras. Cir.

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OBJETIVO: Avaliar os resultados da ureterolitotomia retroperitoneoscópica no tratamento do cálculo ureteral e a necessidade do cateter duplo J para reduzir complicações relacionadas ao procedimento. MÉTODOS: Estudo retrospectivo comparativo de 47 pacientes operados pela técnica de ureterolitotomia retroperitoneoscópica, dos quais 31 foram selecionados e divididos em dois grupos: Grupo 1, cujos pacientes não receberam cateter duplo J, e Grupo 2, que foram submetidos ao implante de cateter duplo J transoperatório. Foram coletados dados de urografia excretora pré e pós-operatória, tempo cirúrgico, analgesia pós-operatória, tempo de internação e retirada do dreno. RESULTADOS: Os grupos foram semelhantes quando comparados na idade e sexo, grau de dilatação do trato urinário, posição e tamanho médio do cálculo (Grupo 1= 15,5 ± 6,6mm; Grupo 2= 16,3 ± 6,1mm). O tempo operatório também não teve diferença significativa (Grupo 1= 130 ± 40,3min; Grupo 2= 136,3 ± 49,3min). O Grupo 1 apresentou seis pacientes (37,5 %) com complicações precoces (quatro casos de fístula urinária) e tardias (um caso de estenose de ureter, um caso de exclusão funcional do rim operado), enquanto o Grupo 2 não teve complicações, sendo esta diferença estatisticamente significativa (p=0,011). CONCLUSÃO: O emprego do cateter duplo J foi associado a um número significativamente menor de complicações na ureterolitotomia retroperitoneoscópica. Tempo cirúrgico, analgesia pós-operatória e tempo de internação foram semelhantes entre os grupos com e sem cateter.

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Experience and Learning Curve of Retroperitoneal Laparoscopic Ureterolithotomy for Upper Ureteral Calculi

Abstract: Retroperitoneal laparoscopic ureterolithotomy is safe and effective for large or impacted stones of the upper ureter. It is associated with a short learning curve in the setting of an active laparoscopic practice for selected patients.

Cited by 26 publications

References 17 publications

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

O emprego do cateter duplo J diminui as complicações na ureterolitotomia retroperitoneoscópica

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