Laparoscopic Ureterolithotomy: A Prospective Comparative Study

Abstract

Introduction: With the developments of non invasive and minimally invasive technology in the management of urolithiasis, the choice of open surgery is rapidly decreasing. The optimal modality of stone management is governed by multiple factors like stone parameters, patient character, availability of technology and surgeon's skill. Open or laparoscopic ureterolithotomy can be used as primary treatment option for large, impacted ureteral stones of more than 1.5 cm or as an adjunct procedure in case of failed ESWL and attempted URS or PCNL.Methods: This is a prospective comparative study to see the outcome of Trans-peritoneal Laparoscopy Ureterolithotomy (TPLU) with Open Ureterolithotomy (OU). Out of 42 patients 21 had undergone laparoscopic ureterolithotomy and same number had undergone open surgery over the period of two and half years. The variables evaluated were age, sex, stone character, operative time, Visual Analogue Scale (VAS) for pain, complications and hospital stay.Results: The patient and disease characteristics in both groups were comparable. Mean operative time was 107.62 ± 32.84 mins in TPLU VS 65.48 ± 15.72 mins in OU group. Median hospital stay was 2.19 ± 1.78 days in TPLU VS 4.62 ± 1.53 days in OU group. The pain score is significantly low in TPLU than OU (p < 0.05).Conclusion: Laparoscopic ureterolithotomy is a safe and feasible treatment option for the selected ureteric stone with comparable outcomes.

Comparison of Open Ureterolithotomy and Laparoscopic Ureterolithotomy in Ureteral Stones at Rural Hospital

“…Wani and Durrani's study [10] also stated that all cases of ureteral stones treated with a laparoscopic retroperitoneal procedure were successful. After three months of follow-up, CT urography results of all patients showed that the ureters were within normal limits, so a stone-free rate of 100% could be stated [8], [10], [12]. This study also found that the success rate of the laparoscopic procedure was 94.1%.…”

“…The demographic data shows that the mean age of the sample is 44.19 ± 11.8 years (transperitoneal laparoscopic ureterolithotomy) and 40.05 ± 12.2 years (open ureterolithotomy), with men still dominating, namely 18/3 patients (trans-peritoneal laparoscopic ureterolithotomy) and 13/8 patients (open ureterolithotomy). Stone size in this study was a mean of 17 ± 5 mm in the trans-peritoneal laparoscopic ureterolithotomy group and 15 ± 5.2 mm in the open ureterolithotomy [8].…”

“…This study also found that men still dominated with a total of 17 patients (open ureterolithotomy) and 19 patients (laparoscopic laparotomy) with an average stone size of 2.5 ± 0.69 cm (open ureterolithotomy) and 2.3 ± 0.78 cm (laparoscopic laparotomy) [7]. Study of Giri et al [8] also conducted a study to see the comparison of open ureterolithotomy and trans-peritoneal laparoscopic ureterolithotomy. The demographic data shows that the mean age of the sample is 44.19 ± 11.8 years (transperitoneal laparoscopic ureterolithotomy) and 40.05 ± 12.2 years (open ureterolithotomy), with men still dominating, namely 18/3 patients (trans-peritoneal laparoscopic ureterolithotomy) and 13/8 patients (open ureterolithotomy).…”

“…The results of this study show that the average operating time is 107.62 ± 32.84 minutes (TPLU) and 65.48 ± 15.72 minutes (OU) with a median length of stay of 2.19 ± 1.78 days (TPLU) and 4.62 ± 1.53 days (OU). The pain score at TPLU was significantly lower than that at OU, with a p-value <0.05 [8].…”

“…Study Simforoosh et al [12], who compared URS, percutaneous nephrolithotomy (PCNL), and laparoscopy, found that stone-free rates for each group were 56%, 64%, and 88%. A study by Giri et al [8] also found that stone clearance with a laparoscopic procedure was 100% with a conversion rate of 8.14% and one case of re-operation due to a persistent leak from the ureter. Wani and Durrani's study [10] also stated that all cases of ureteral stones treated with a laparoscopic retroperitoneal procedure were successful.…”