A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

Abstract

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience

“…PNL is another treatment option in the treatment of large ureteral stones that cannot not be reached retrogradely and located in the ureteropelvic junction [13]. Furthermore, pushing the stone back to the renal pelvis and performing a percutaneous approach can be an alternative technique to L-RU and F-URS.…”

“…Furthermore, pushing the stone back to the renal pelvis and performing a percutaneous approach can be an alternative technique to L-RU and F-URS. Studies in the literature reported high success rates as 86-100% with PNL using these techniques [13,14,15]. In a recent study, Long et al evaluated the efficacy and safety of mini-PNL in the treatment of large proximal ureteral stones [16].…”

“…The most important advantage of retroperitoneal approach over the transperitoneal one is that there is no need to cut the peritoneum or mobilize the internal organs, and the other benefit is the absence of contact of the peritoneal structures with urine [13]. Comparative studies of L-RU showed that this procedure was more successful when compared to endourological procedures, but patients who stayed in hospital longer had more pain [1,19].…”

CUA Guideline: Management of ureteral calculi

“…131 For large (>15 mm), impacted proximal ureteral stones, the stone-free rate with antegrade URS ranges between 98.5% and 100% with a low risk for complications. 130,[132][133][134][135][136] Laparoscopic, robotic or open ureterolithotomy may be considered when ureteroscopic and percutaneous procedures have failed or concomitant surgery is required. …”

Metabolic risk factors and formation of urinary stones. Study III: Effect of urine pH

“…Ureteral avulsion and strictures are rare (< 1%). Previous perforations are the most important risk factor for complications.3.4.3.1.4.2 Percutaneous antegrade ureteroscopy Percutaneous antegrade removal of ureteral stones is a consideration in selected cases, i. e. large, impacted proximal ureteral calculi with dilated renal collecting system[284], or when the ureter is not amenable to retrograde manipulation[259,[285][286][287][288]. Percutaneous antegrade removal of ureteral stones is an alternative when SWL is not indicated or has failed, and when the upper urinary tract is not amenable to retrograde URS.…”