Laparoscopic Ureterolithotomy in Children: With and Without Stent — Initial Tertiary Care Center Experience with More Than 1-Year Follow-Up

Abstract

The purpose of our study was to assess the safety and feasibility of transperitoneal laparoscopic ureterolithotomy (LU) in children with ureteric stones with and without a stent. Impacted ureteric stone of size ≥ 1.5 cm or ureteric stones that were refractory to shock wave lithotripsy (SWL)/ureteroscopy (URS) were considered for LU. From December 2009 to April 2012, 50 cases of LU were performed with a stent being placed. From May 2012 onward we now perform stentless LU and till now we have done approximately 64 such type of cases. Out of these, 48 have completed more than 1 year of follow-up and we took these as our study group and the previous 50 (LU with stent) as our control group. Baseline characteristics along with certain per- and postoperative findings of the two groups were noted and analyzed. Ultrasonography and X-ray kidney, ureter, and bladder region were done at 3, 9 months, 1 year, and yearly thereafter. Intravenous urography was done at 6 months statistical analysis was performed by using SPSS ver. 21 (SPSS Inc., Chicago, Illinois, United States). The data were analyzed by using the Mann-Whitney test and a value of < 0.05 was considered significant. The baseline characteristics were similar in both the groups with 100% stone clearance in all. LU with stent differed from the stentless group in terms of more requirement of analgesics and the need for a second procedure for stent removal, but with no cases of urine leak in the postoperative period. LU in children is a safe and viable option, especially for impacted stones or as a salvage procedure for ureteric stones when SWL or transureteral lithotripsy has failed.

How safe and effective is stentless laparoscopic ureterolithotomy in elderly patients?

“…You et al assessed 41 patients who underwent retroperitoneal LU (stented [n = 17] vs stentless [n = 24]) retrospectively, demonstrated except for the duration of surgery, no significant differences existed in estimated blood loss, hospitalisation time and time to drain removal 28 . Srivastava et al assessed 98 paediatric patients who underwent transperitoneal LU (stented [n = 50] vs stentless = [n = 48]) in the stented LU group, there was a higher analgesic requirement and a second procedure for stent removal, but there was no urine leak in both groups 29 . Ureteral stenosis is one of the major complications of LU.…”

“…27 in the stented LU group, there was a higher analgesic requirement and a second procedure for stent removal, but there was no urine leak in both groups. 29 Ureteral stenosis is one of the major complications of LU.…”

Ureteroscopy in Children-A Single Centre Study from a Developing Country

“…One of the concerns in children undergoing SWL is the fear of possibility of procedure failure or need for repeat SWL session if stone is not completely cleared in first session of SWL [16]. Ureteric stone disease poses challenge to the treating urologist in children due to fear of complications while inserting a semi rigid ureteroscope into a relatively thin ureter in children [17].…”

“…According to their findings, it was noted that more children required additional sessions of SWL after initial shock wave lithotripsy.Keeping in view this phenomenon more children are likely to undergo URS as initial treatment modality for management of ureteric stones [13]. In modern countries URS has now become a safer procedure in pediatric population as well [17,18]. However in developing counties it's still in nascent stages and is not used widespread.…”