When is open ureterolithotomy indicated for the treatment of ureteral stones?

Abstract

Aim: Improvements in extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy have almost eradicated the need for open surgery in ureteral stones. The aim of this study was to assess characteristics of patients who underwent open ureterolithotomy. Methods: During a 5-year period, a total of 654 patients with ureteral stones were treated. Initial management consisted of ureteroscopy in 524 patients, ESWL in 62 patients and percutaneous nephrolithotomy (PCNL) in 12 patients. Open surgery was performed in 56 patients. Stone location, size and success rates were retrospectively analyzed. Results: Ureteroscopy resulted in successful stone removal in 94%, 98% and 98.5% of proximal, mid and distal ureteral stones, respectively. A total of 14 patients with ureteroscopy failure were referred for open surgery. ESWL treatment resulted in success in 55 patients (88%), and those with ESWL failure were referred for either ureteroscopy (n = 3) or open surgery (n = 4). Open surgery was performed in a total of 56 patients, 38 of whom had been referred from other centers. Stone location was proximal ureter in 25 (44.6%) patients (stone size: 2-12 cm 2 ), mid ureter in five (8.9%) patients (stone size: 2-6 cm 2 ) and distal ureter in 26 (46.4%) patients (stone size: 4-9 cm 2 ). A history of previous unsuccessful endourological procedure was observed in 33 (58%) of 56 patients. Children under age 16 (range 1-15 years) comprised 17.8% of patients undergoing open surgery. Conclusion: Open surgery, which is nowadays being replaced with laparoscopic techniques, is generally indicated for failed endourological procedures (58%), particularly in centers that do not have flexible ureteroscopy or laser lithotriptor, and in patients with larger stones (>3 cm). Children (17.8%) are also candidates for open surgery, if specifically designed endourological equipment is not available.

Experience of Mini-Percutaneous Nephrolithotomy in the Treatment of Large Impacted Proximal Ureteral Stones

“…Some urologists have recommended laser lithotripsy as first-line treatment [15,16] and many articles reported that a stone-free rate for calculi <10 and >10 mm was 90-100 and 88-93%, respectively [17,18,19,20]. Though a high stone clearance rate was attained, attention should be paid to the complications.…”

Open Ureterolithotomy In an Era of Endoscopic Surgery for a Patient with Spina Bifida: Was It an Appropriate Decision?

“…A distorted anatomy along the ureter or restricted movement of the hip and lower limbs potentially makes ureteroscopy difficult, if not impossible. In fact, abnormal anatomy, large stones of at least 3 cm, and endoscopic failure constituted a majority of the indications of open surgery [5,6]. The provision of flexible scopes could overcome this access issue, but its inherent restricted capabilities make them an undesirable choice in eradicating ureteric stones, especially if the stone burden is substantial.…”

Taş Hastalığında Açık ve Laparoskopik Cerrahinin Yeri Var Mı?

“…Buna karşın, büyük (>1.5 cm) ve sert taşlarda başarısı düşüktür (48) Fleksibl aletler ile birlikte holmium lazerin kullanılmasıyla üreterore-noskopinin başarı oranı %98 olarak saptanmıştır (49). Fakat özellikle gelişmekte olan ülkelerde bu tekniğin maliyeti önemli bir dezavantajdır (50).…”