Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis

Abstract

To evaluate the safety and efficacy of retroperitoneal laparoscopic ureterolithotomy (RLU) in the treatment of proximal ureteral stones accompanied with obstructive pyelonephritis without preoperative drainage.We retrospectively reviewed 21 cases of proximal ureteral stones with infected kidney undergoing RLU between July 2013 and September 2016. Stone-induced obstructive infected hydronephrosis was diagnosed using blood and urine tests and imaging modalities. Empirical effective broad spectrum antibiotic therapy was initiated immediately, and then urgent RLU was performed without preoperative drainage. During the surgical procedure, infected urine was also aspirated before stone was removed. Preoperative, intraoperative, and postoperative clinical data were collected.Operations were performed successfully without open conversion or blood transfusion. The mean operation time was 69.3 ± 12.33 minutes. For all the patients, the level of plasma procalcitonin decreased after RLU. The mean hospital stay duration was 6.4 ± 1.54 days. No septic shock or other severe complications occurred. By discharge, the body temperature and hemogram of each patient returned to normal. A 100% stone-free rate was achieved.Our study suggests that RLU is a potentially safe and effective method to treat proximal ureteral stones accompanied with obstructive pyelonephritis without any need of preoperative drainage.

Outcome of Transperitoneal Laparoscopic Ureterolithotomy (TPLU) for proximal ureteral stone > 15 mm: Our experience with 60 cases

“…The most common indication of TPLU in our study was primary procedure for impacted upper stones in 51.7% of patients, followed by failed ESWL in 35%, and failed URS in 13.3% of cases. Our results are similar to previous papers such as those of Huan et al(14), El-Moula et al(2), and Nasseh et al(15). In our report, 61.7% of patients had severe HDN.…”

Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm

“…The relatively low incidence of infection in RPLU group may be associated with no elevated intra-pelvic pressure during the whole procedure. [24,25] KUB plain film showed that abnormal position of DJ stent occurred in both groups on the first day after operation. The cases with abnormal position of DJ stent in RPLU group was more than that in MPCNL group.…”

“…Third, purulent urine was found after percutaneous nephrostomy in three patients and staged operation was performed. The relatively low incidence of infection in RPLU group may be associated with no elevated intra-pelvic pressure during the whole procedure [24,25] …”

“…The relatively low incidence of infection in RPLU group may be associated with no elevated intra-pelvic pressure during the whole procedure. [ 24 , 25 ]…”

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

“…Active intervention is needed to assist in removing stones, especially stones that have caused obstruction or are large in size. Two active interventions can be shockwave lithotripsy (SWL) or ureteroscopy (URS) [1], [2].…”