Comparison of Ureteroscopic Laser Lithotripsy with Laparoscopic Ureterolithotomy for Large Proximal and Mid-Ureter Stones

Abstract

Objectives: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. Material and Methods: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. Results: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. Conclusions: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

Laparoscopic Ureterolithotomy vs Ureteroscopic Lithotripsy for Large Ureteral Stones

“…Kaygisiz et al 6 recently reported similar 3-month stone-free rates with UL when compared to LU for large upper and midureteral stones (96.6% vs. 100%, P = .483). 5 However, they included slightly fewer upper ureteral stones cases in the UL group than in the LU group (51.7% vs. 77.4%).…”

“…With regard to hospital stay duration, our results indicated slightly longer durations than those reported in other studies. 6,7 This could be due to differences in healthcare systems and cultural backgrounds. For instance, Korean patients usually remain in the hospital until the surgical suture is removed.…”

“…Indications have been confined to select cases, and this technique is considered a final surgical modality for cases of previous SWL or endoscopic failure, large impacted stones, anatomic anomalies, etc., 4 Currently, LU seems to be primarily indicated for large impacted stones and demonstrates successful stone clearance rates of nearly 100%. 5–6…”

Using retroperitoneal laparoscopic ureterolithotomy in the treatment of impacted upper ureteric calculi

“…ESWL may not be effective because impacted calculi are usually wrapped around or adhere to ureteral polyps. When this happens, URL or FURS are options for treatment, but they can have a lower clearance rate and greater risk of complications (3)(4)(5). When URL treats the upper ureteral stones, the…”

Laparoscopic ureterolithotomy for large proximal ureteric stones: Surgical technique, outcomes and literature review

“…For stones ≥15 mm, data are lacking in the literature, and the ideal treatment option is not defined yet. Few studies have discussed the outcomes of LPU in the treatment of stones ≥15 mm and have shown high stone‐free rates (SFRs) and low auxiliary procedure rates 6‐15 . Ureteric stones that remain in the same site for a period of 8 weeks causing local inflammation are called impacted ureteric stones 16,17 .…”