Does laparoscopy has a place in managing urinary stones in the era of mini- and micro-PCNL

Abstract

Introduction: Surgical management of urinary stones has witnessed major development in the last few decades. After the successful introduction of Shock wave lithotripsy (SWL), the urologist's armamentarium for treating stones became versatile by adoption of rapidly evolving technologies that increasingly replaced the traditional open surgery.There are special situations when SWL and endourology is not the optimal choice and open surgery was the only option at a time, here comes the role of laparoscopy to replace the open surgery for dealing with these cases where endourology has major limitations. Hereby we will highlight the current international trend in laparoscopic surgery for urolithiasis and demonstrate our limited experience in laparoscopic stone surgery in ten patients in Aden, Yemen. Patient and Method: From March 2011 to September 2017. Ten consecutive patients' ages 4-60 years (mean 38 years) with renal and ureteral stones underwent laparoscopic removal of their stones. The indications for laparoscopy were; unavailability of pediatric PNL setup in two children, failed of SWL in one, renal stones with concomitant PUJO in one, and large impacted ureter stones in the rest of patients. Result: Stone largest diameter ranged from 25 to 45 mm (mean 28 mm), operative time ranged from one to 4 hours (mean 2.3 hours) and hospital stay ranged from four to seven days (mean 5 days). The procedure completed successfully an all, but one patient in whom conversion to open ureterolithotomy performed, because of difficulty to access the large impacted intramural stone, no major intra or post-operative complications, no blood transfusion needed. One patient develop prolonged urine leakage for 10 days managed conservatively. Follow up after three, six and 12 months with plain abdominal x-ray (KUB) ultrasonography (US) and Urography (IVU) when indicated showed no residual stones and no newly developed hydronephrosis. Conclusion: Laparoscopic surgery is safe and effective in management of large renal and ureter stones in patients who are not suitable candidate for endourology.