Laparoscopic ureterolithotomy: Its role and some controversial technical considerations

Abstract

Objective: To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. Methods: Between July 1997 and December 2004, retroperitoneoscopic ureterolithotomy was performed as a primary procedure in 30 patients who had either large or impacted stones in the upper ureter. The other indications were stones which could not be fragmented by shock wave lithotripsy or the patients could not afford the cost of shock wave lithotripsy. The mean (range) age of the patients was 44.07 years (17-78) and the mean (range) stone size was 19.03 mm (10-40). The ureter was closed with intracorporeal laparoscopic suture without placing a stent. Results: The stone was removed in all but one case. The mean (range) operative time was 121.38 min . No intraoperative complications were recorded. The mean (range) postoperative drain removal was 2.86 days (2-10). Postoperative complications included prolonged urinary leakage in one patient. On the sixth month of follow up, all patients were stone free without any evidence of ureteral stricture. Conclusion: Laparoscopic ureterolithotomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted upper ureteric stones. The technical recommendations were retroperitoneal access and suturing the ureterotomy incision. Ureteral stent should be placed in only cases of severe inflammation of the ureter or inappropriate suturing.

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

“…Compared with the findings of Basir et al 24 and El-Moula et al 10 , who reported lengths of stay of 5.8 and 6.4 days, respectively, it can be seen that this series had a better hospitalization time. Also compared to Kijvikai Patcharatrakul and 15 and Bove et al 26 , the time of drain removal of 2.8 and three days was similar to the one found here.…”

“…The double-J catheter use in this circumstance is not a consensus. Many authors advocate that the minimally invasive approach with careful handling of the ureter may be sufficient for proper healing of the body, without complications and without the use of a ureteral stent 12,14,15,16 . In the reported series of laparoscopic ureterolithotomy, many patients were treated without the use of ureteral stent, with few complications reported.…”

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

“…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. The absence of urine leakage after laparoscopic nephrectomy in the study by Nambirajan et al [23] might be the cause of a similar postoperative period and morbidity of the two groups.…”

Laparoscopic Stone Surgery: One Surgeon Experience

“…Some authors defined the importance of double j stent and sutures (12,13). Kijvikavi et al (12) suggested only ureteral stent because of chronic inflammation in ureteral mucosa. The authors reported that there was no ureteral stricture in the series of 213 patients (6).…”