Laparoscopic Transperitoneal Ureterolithotomy: A Single-Center Experience

Abstract

This study aimed to evaluate success and complications of laparoscopic transperitoneal ureterolithotomy at our center. From November 2008 until September 2011, 33 patients, including 22 men and 11 women, with a mean age of 45.3 years (range, 19-67 years), underwent laparoscopic ureterolithotomy at our center. Locations of stones were the upper, middle, and lower ureter in 29, 1, and 3 patients, respectively. Ten patients had a history of previous abdominal or pelvic surgery. Laparoscopic ureterolithotomy was performed via a transperitoneal approach. Complications and outcomes were evaluated. Mean operation time was 85.48±15.11 minutes. Except for one stone migration and one conversion to open surgery, all the ureteral stones were extracted laparoscopically (94% success rate). A double J stent was inserted antegradely during the procedure and remained for about 1 month in all cases except in 1 patient in whom both antegrade insertion and ureteroscopic relocation were used. Postoperative hypercapnia was detected in a young patient, who recovered with conservative treatment. No visceral complication occurred. The mean hospital stay and the drain installation interval were 4.1 days (range, 3-9 days). The mean return to full activity was 11.91±4.65 days. Preoperative hydronephrosis resolved at follow-up ultrasonography (3 months later) in all patients except 2 cases, in whom intravenous pyelography showed no obstruction (memorial hydronephrosis). Laparoscopic transperitoneal ureterolithotomy is a safe and effective treatment modality for skilled surgeons and a convenient option for patients. Challenges, such as lower ureteral stones, redo cases, and antegrade double J stent insertion, can be overcome by experience.