Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

Abstract

Objective: This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. Material and methods:A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.Results: There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p= 0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Conclusion:Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.

Outcome of Transperitoneal Laparoscopic Ureterolithotomy (TPLU) for proximal ureteral stone > 15 mm: Our experience with 60 cases

“…Keeley et al reviewed their experience with TPLU in 14 patients; in their study, low grade fever was detected in one patient(26). In the study by Khalil and coworkers, postoperative fever was observed in 15.4% of the TPLU group(27). In our study, low grade fever was present in 8 (13.3%) patients which relieved by administration of a suitable antipyretic drug.…”

“…Blood transfusion was needed to restore the hemodynamic state in 8 (13.3%) patients. In the study by Khalil and coworkers, the need for blood transfusion in the TPLU group was 15.4%(27). Chen et al, comparing safety and efficacy between TPLU and RLU for proximal ureteral stones > 10 mm, mentioned that the overall rate of blood transfusion was 2.8%(12).…”

Bilateral Synchronous 3-Port Trans-peritoneal Laparoscopic Ureterolithotomy: a Case Report

“…LUL with both trans-peritoneal and retroperitoneal techniques have been used for large impacted ureteric calculi, with stone size more than 15 mm, and it has been found that both approaches are effective. The trans-peritoneal technique has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake [ 3 ].…”

Bilateral Synchronous 3-port Transperitoneal Laparoscopic Ureterolithotomy: A Case Report

“…LUL with both transperitoneal and retroperitoneal techniques have been used for large impacted ureteric calculi, with stone size more than 15 mm and it has been found that both approaches are effective. The transperitoneal technique has signi cantly shorter operative time and lower rate of open conversion but has a signi cantly longer time to oral intake [3].…”