Laparoscopic urinary stone surgery: an updated evidence-based review

Abstract

The treatment of urinary lithiasis has been revolutionized during the last three decades. Minimally invasive therapies in the form of endoscopic surgery in companion with the advent of shock wave lithotripsy have diminished the role of open stone surgery. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. We have tried to identify the level of the evidence and grade of recommendation, according to the evidence-based medicine criteria, in studies supporting the laparoscopic approach to stone extraction. The highest level of evidence (IIa) was found for laparoscopic ureterolithotomy. It is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity compared to open ureterolithotomy. It is mostly recommended (grade B) for large impacted stones or when endoscopic ureterolithotripsy or shock wave stone disintegration have failed. Laparoscopic pyelolithotomy is feasible but rarely indicated in the present era (III/B). Laparoscopic nephrolithotomy may be indicated to remove a stone from an anterior diverticulum or when PNL or flexible ureteroscopy have failed (III/B).

Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature

“…The European Association of Urology (EAU) Guidelines on urolithiasis of 2013 summarized the indications for laparoscopy, which include stones in caliceal diverticula, stones in anomalous and/or ectopic kidneys, and stones associated with UPJO when other minimally invasive procedures are not indicated or have failed 5. In a systematic review, Skolarikos et al determined that the highest level of evidence supporting the role of laparoscopy in the management of lithiasis was IIa for laparoscopic ureterolithotomy 6. However, Lusuardi and Janetschek suggested that laparoscopy can be offered as first-choice treatment when anatomic abnormalities are involved, such as UPJO 7.…”

Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India

“…Keeley et al [15] reported the advantages of transperitoneal laparoscopic ureterolithotomy in which there is high probability of removing the entire stone burden in one procedure. In an evidence-based review by Skolarikos et al [16], the highest level of evidence (IIa) was found for laparoscopic ureterolithotomy supporting the laparoscopic approach of stone extraction and mostly recommended (grade B) for large impacted stones or when endoscopic techniques have failed. Due to scarcity of complex and large stones nowadays, there are few studies which actually compared the laproscopic and open techniques of ureterlithotomy in prospective design and most of the previous laparoscopic studies are unrandomized and not actually comparative [17,18,19].…”

Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm

“…The highest level of evidence was IIa for laparoscopic ureterolithotomy and recommended (grade B) for large impacted ureteral stones or when endoscopic ureterolithotripsy or shock wave lithotripsy (SWL) has failed [5].…”