A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

Hikmet Topaloglu,Sercan Sari,Hamit Ersoy,Nihat Karakoyunlu,Levent Sagnak,Hakki Ugur Ozok

doi:10.1155/2014/691946

Abstract

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

Highlights

Current treatment of proximal ureteral stones poses a challenge especially in large and impacted stones, or when shock wave lithotripsy (SWL) and retrograde ureteroscopy fail
Both percutaneous antegrade ureteroscopy (PAU) and retroperitoneal laparoscopic ureterolithotomy (RLU) appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL
Percutaneous antegrade extraction of ureteral stones may be considered in some selected cases including very large impacted stones located at proximal ureter or between ureteropelvic junction and lower border of the 4th lumbar vertebra [1, 2]. It may be considered as an option when SWL is not indicated or failed [3] or when upper urinary system cannot be accessed with retrograde ureteroscopy

Summary

Introduction

Current treatment of proximal ureteral stones poses a challenge especially in large and impacted stones, or when SWL and retrograde ureteroscopy fail. Percutaneous antegrade extraction of ureteral stones may be considered in some selected cases including very large (diameter ≥ 15 mm) impacted stones located at proximal ureter or between ureteropelvic junction and lower border of the 4th lumbar vertebra [1, 2]. It may be considered as an option when SWL is not indicated or failed [3] or when upper urinary system cannot be accessed with retrograde ureteroscopy

Objectives

Methods

Results

Conclusion