Role of the gonadal vessels on the stone lodgment in the proximal ureter: Direct observation during laparoscopic ureterolithotomy

Abstract

Introduction: Previous radiological studies revealed that stones lodge more frequently in the ureterovesical junction (UVJ) as well as the proximal ureter. Factors that prevent stone passage from the proximal ureter are not well studied. Aim: To explore the site of the lodged stones in the proximal ureter with direct observation during laparoscopic ureterolithotomy. Materials and methods: Between November 2014 and February 2015, we included 26 patients including 18 men and 8 women with stones larger than 10 millimeters in the proximal ureter who were candidate for laparoscopic ureterolithotomy. We prospectively recorded the site of the lodged stones in the ureter during laparoscopic ureterolithotomy in relation with the sites of ureteral stenosis as well as the gonadal vessels. Results: Among 26 patients with ureteral stone, in 19 cases stone was found close to the gonadal vein compared with seven cases that stone was in other locations of the ureter (p = 0.02). The characteristics of patients and stones were not different in cases that the stone was close to gonadal vessels compared with other locations. Conclusions: This study showed that most of the stones lodged in the proximal ureter were in close proximity with gonadal vessels. Gonadal vessels may be an extrinsic cause of ureteral narrowing.

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

“…The global issues that affect the time of operation are the time to identify the ureter, identification of the stone location, skillful passage of the catheter stent with antegrade approach, and quick intracorporeal suturing of the ureter. Identification of the ureter might be difficult and frustrating (18,19). In our study, we had problematic ureteric identification in some patients.…”

Retroperitoneal vs. Transperitoneal Laparoscopic Pyelolithotomy; a single surgeon’s experience

“…In addition, LPL is linked to a reduced rate of kidney stone recurrence in the future [14]. Moreover, laparoscopic vision may provide data about the possible undiagnosed anatomical factors causing stone lodgment [15]. From the sum of the meta-analyses and despite the heterogeneity that exists regarding the operation time, length of hospitalization, and the amount of bleeding, it can be claimed with a high level of evidence that the rate of stone removal in laparoscopic pyelolithotomy for single and large pelvic stones is higher than PCNL.…”

Does Tamsulosin use before Ureteroscopy Increase the Success of the Operation?

“…2 Ureteral stone treatment consists of observation, medical expulsive therapy (MET), ureteroscopy (URS), and ureterolithotomy. 3,4 Selective alpha-blockers are widely used in MET treatment. In many previously published meta-analyses, European Association of Urology and the American Association of Urology recommend this treatment, because it increases the rate of spontaneous stone passage of ureteral stones.…”