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

Abstract

Introduction We evaluated the efficacy and safety of laparoscopic ureterolithotomy (LPU) for the treatment of large proximal ureteric stone. Methods A retrospective multicenter analysis for patients with solitary impacted proximal ureteric stone ≥15 mm who underwent LPU from 2016 to 2019 was performed. Primary outcome was to estimate the stone‐free rate (SFR). SFR was defined as absence of residual stones on postoperative computed tomography scan. Secondary outcome was to assess the perioperative outcomes, as well as to review literature data of randomized controlled trials and meta‐analyses comparing LPU to other treatment options. Results Forty‐four patients were included in our study. Mean stone size was 22.9 ± 5.8 mm and median follow‐up was 14 months. Three patients had previous abdominal surgery, one patient had severe degree of scoliosis and six patients failed primary therapy. All stones were extracted successfully (SFR = 100%) without need of auxiliary treatments. Mean operative time and estimated blood loss were 86.6 ± 14.1 minutes. and 11.9 ± 14.7 mL, respectively. No intraoperative complications or conversion to open surgery were reported. No major postoperative complications (≥grade 3) were reported. Mean length of hospital stay was 2 ± 0.8 days. Conclusions For treatment of large ureteric stones, our study showed that LPU achieves 100% stone‐free status. When performed by well‐trained laparoscopic surgeons, it is safe and has no major perioperative complications. According to our results and literature data, when counseling patients with large impacted proximal ureteral stones, LPU should be advised as the procedure that has the higher SFR, lower auxiliary treatments, and comparable complication rates to other treatments.

Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5–2.0 cm in diameter

“…For example, ureteral rigidoscopy is a complicated procedure for the treatment of stones in the upper ureter and has a low success rate as the stones tend to travel up to the renal pelvis during the surgery. Another option, laparoscopic surgery is indicated for complex and large stones and has been gradually replaced in recent years due to the high degree of trauma and slow postoperative recovery [ 12 – 14 ].Also, extracorporeal shock wave lithotripsy is suitable for patients with upper ureteral stones, the postoperative residual fragments limit its acceptance among patients [ 15 – 17 ].…”

Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5-2.0cm in diameter

“…For example, ureteral rigidoscopy is a complicated procedure for the treatment of stones in the upper ureter and has a low success rate as the stones tend to travel up to the renal pelvis during the surgery. Another option, laparoscopic surgery is indicated for complex and large stones and has been gradually replaced in recent years due to the high degree of trauma and slow postoperative recovery [12][13][14].Also, extracorporeal shock wave lithotripsy is suitable for patients with upper ureteral stones, the postoperative residual fragments limit its acceptance among patients [15,16].…”

Laparoscopic ureterolithotomy and retrograde flexible ureteroscopy-assisted transperitoneal laparoscopic ureteroureterostomy for a huge ureteropelvic junction stone and multiple small renal stones

“…[7] In addition, the flexibility of a flexible ureteroscope is limited in a renal pelvis with high-grade hydronephrosis, which then affects the operation field and stone-free rate. [8,9] On the other hand, laparoscopic ureterolithotomy (LUL) has been shown to be non-inferior to retrograde flexible ureteroscopy (fURS) in stone-free rate and the need for axillary procedures, and to have a significantly lower rate of post-operative sepsis with huge ureteral [10][11][12][13] In this article, we report the case of a 66-year-old male patient who had previously undergone endoscopic management with double-J catheter (D-J) stenting but still had a heavy stone burden in the ureteropelvic junction (UPJ) and lower pole renal calyx. We conducted LUL with laparoscope-assisted retrograde intrarenal surgery (LA-RIRS) for residual stones and achieved excellent results.…”