Laparoscopic ureterolithotomy: technical considerations and long‐term follow‐up

Abstract

Objective To analyse the technical details and the longterm results of laparoscopic ureterolithotomy. Patients and methods Laparoscopic ureterolithotomy was undertaken in 101 patients between 1991 and 2001; in only one patient with retroperitoneal ®brous adhesions was the procedure transperitoneal, being retroperitoneal in all the others, using Gaur's balloon retroperitoneoscopy. The mean (range) stone size was 16 (10±47) mm, and the stones were in the upper ureter in 75, mid-ureter in 11 and lower ureter in 15 patients. Nine patients had more than one stone, the maximum being six, in a megaureter. Most were impacted for >2 months, the maximum being 240 months. Results Laparoscopic ureterolithotomy was successful in 93 patients, with the eight failures being mostly early in the series. The mean operative duration was 79 min (66 min when the ureter was left open and 92 min when it was sutured). The overall mean duration of urinary leakage was 5.5 days, which was reduced to 3.2 days by stenting and suturing the ureter. The mean (range) blood loss was 25 (5±100) mL. The overall complication rate was high (31%) because of prolonged urinary leakage in 20 patients. No patient required morphine for pain relief and the mean for oral analgesic use was 2.5 days. The mean hospital stay was 3.5 days and that for resuming work 14 (7±28) days. Conclusions Laparoscopic ureterolithotomy by the retroperitoneal approach is a safe and reliable minimally invasive procedure. Although its role as a salvage procedure for failed extracorporeal shock wave lithotripsy and ureteroscopy is undisputed, in selected patients with large chronically impacted ureteric stones and particularly with solitary kidneys, it may be considered the ®rst-line treatment.

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

“…The choice was due to the size of the calculus and time of obstruction, the position and anatomy of the urinary tract, and especially the fact that there was no usable flexible ureteroscopy and / or lithotripsy device, due to low socioeconomic status of the population. Gaur et al 12 and Matthias et al 22 selected the retroperitoneoscopic ureterolithotomy as primary treatment in 59% and 55%, respectively. Both reinforce the socioeconomic status as a major factor in the therapeutic option.…”

“…Gaur et al 12 described the largest series operated by retroperitoneoscopic approach. The authors stressed that the use of ureteral stent reduces the leakage of urine, but did not recommend this type of drainage routinely, only in special situations, such as chronic inflammation, marked edema, friability and ureter calculus impacted for a long period.…”

“…The procedure-related complications were reported by some authors, but the number is small and usually easily treated. These are mainly the prolonged urine leakage through the drain and postoperative ureteral stenosis 11,12,13 . The double-J catheter use in this circumstance is not a consensus.…”

“…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.…”

Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

“…Laparoscopic ureterolithotomy was first described by Wickham in 1979 [14]. Gaur et al [5], having developed an innovative balloon dissection technique, have since described the largest series of >100 cases over 10 years. These results are admirable although, from the present series, MAU would appear to be quicker, cheaper and require far less specialized equipment.…”