Laparoscopic ureterolithotomy: Our experience with 74 cases

Abstract

Objectives:We retrospectively evaluated our experience with a relatively uncommon procedure, the laparoscopic ureterolithotomy, for the treatment of ureteral stones. Methods: Between April 2002 and October 2006, a total of 74 patients (56 males, 18 females) with upper (54 cases), middle (18 cases) and lower (two cases) ureteral stones underwent laparoscopic ureterolithomy. The mean age was 39.4 years (range, 19-74). The stones were in the right side in 44 cases (59.5%) and in the left side in 30 (40.5%) cases. The mean stone size was 1.8 cm (range 1.5-2.8). The procedure was retroperitoneal in 66 cases (89.2%) and transperitoneal in eight (10.8%) cases. Laparoscopic guided flexible ureterorenoscopic extraction of kidney stone was carried out in one case as an adjuvant procedure. The ureter was stented and not sutured in 64 cases (86.5%). Results:The procedure was successfully completed in 94.6% of cases and an open conversion was carried out in four (5.4%) patients. The mean operative time was 58.7 min, and the mean blood loss was 90.6 mL. No major complications were encountered. Prolonged urinary leakage occurred in one patient. The mean hospital stay was 6.4 days. One patient developed ureteral stricture during follow up and was treated by endoscopic dilatation and stenting. Conclusion: In our experience laparoscopic ureterolithotomy represents a safe and effective treatment option for ureteral stones either as primary for large impacted stones or as a salvage procedure after failed shock wave lithotripsy or ureteroscopy. This procedure fulfills the advantages of minimal blood loss and analgesia requirements, good cosmetic appearance, short hospital stay and convalescence period.

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.…”

“…Many authors advocate laparoscopic ureterolithotomy as the primary treatment of proximal ureteral calculi, especially in stones larger than 1.5 cm, in obstructive impacted calculi, as well as second-line treatment to refractory calculi from either ureteroscopy or extracorporeal lithotripters wave shock 8,9,10 . The procedure-related complications were reported by some authors, but the number is small and usually easily treated.…”

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

“…Laparoscopic ureterolithotomy can be conducted via a transperitoneal or retroperitoneal approach, both of which are equally challenging. [7,14] In the current study, the patient demographics and stone characteristics in the two groups were homogenous. There was no statistically significant difference between the two groups with regard to the age and sex of patients, mean stone size, stone side, and BMI; this minimized the effect of any of them on the outcomes of the procedures.…”

Estudio prospectivo que compara laparoscopia y cirugía abierta para el tratamiento de cálculos ureterales impactados

“…La decisión acerca de si se ha de suturar la ureterotomía y colocar un stent en el uréter es controvertida. Algunos autores optan por no cerrar la ureterotomía y no colocar un stent en el uréter 14 . Recientemente, El-Moula et al 14 documentaron un estudio retrospectivo multicéntrico de 64 UL retroperitoneales en las que el uréter se dejó abierto con un doble J, y sólo un paciente sufrió una pérdida prolongada de orina.…”

“…Además, el número de pacientes incluidos en los estudios era relativamente reducido, que variaba entre 3 y 101 8,14 . En las publicaciones en lengua inglesa, tan sólo hemos encontrado dos estudios comparativos y no aleatorizados 7,17 .…”