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

Abstract

Purpose: We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. Patients and methods: Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. Results: The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). Conclusions: TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.

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

“…This study rst focused on the upper ureteral stones of 1.5-2.0 cm in diameter although there were plenty of research regarding the treatment of ureteral stones with PCNL or FURSL, as both these 2 surgeries were the most wide-accepted surgeries currently. According to the previous studies, the risk of complications associated with percutaneous nephrolithoscopy, such as bleeding, related to its access diameter [13][14][15]. In this study, we used 16-22F sheath, and it was proved that postoperative complications are greatly declined compared to the standard percutaneous nephrolithoscopy [16].…”

“…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].…”

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

“…This study first focused on the upper ureteral stones of 1.5–2.0 cm in diameter although there were plenty of research regarding the treatment of ureteral stones with PCNL or FURSL, as both these 2 surgeries were the most wide-accepted surgeries currently. According to the previous studies, the risk of complications, bleeding, associated with percutaneous nephrolithoscopy, related to its access diameter, upper caliceal puncture, multiple punctures and increased intra-operative time [ 13 – 15 ]. A perfect puncture to avoid bleeding is achieved by creating a concise and direct pathway that starts from the skin, passes through the subcutaneous tissue, and reaches the cup of calyx (renal papillae).…”