Laparoscopic Treatment of Urinary Stones After Failure of Previous Mini-Invasive Approaches

Abstract

Introduction: Urolithiasis in the general population has been estimated at about 5%–12%, with an annual incidence of just over 1% and recurrence rates close to 50% involving patients of all races, ages, and gender.1 There are several methods for the management of patients with urinary stone disease.1 Within the therapeutic options, we have minimally invasive procedures, such as percutaneous nephrolithotomy (PNL), shockwave lithotripsy (SWL), and endoscopic ureterolithotripsy (EUL). Laparoscopic pyelolithotomy, laparoscopic ureterolithotomy, and laparoscopic cystolithotomy are now considered second-line therapeutic procedures, whereas open surgery still represents an effective more invasive treatment.2 We present our case series on laparoscopic management of renal, ureteral, and bladder stones previously unsuccessfully treated with mini-invasive procedures. Materials and Methods: From September 2010 to April 2012, 18 patients, previously treated with minimally invasive techniques (PNL, SWL, and EUL), underwent laparoscopic surgery for urinary tract stones. Epidemiological, clinical, and surgical variables were reviewed. Clinical variables, such as the presence of unilateral or bilateral stones and their position (renal pelvis, proximal, middle, or distal ureter and bladder), were taken into account. The mean operative time, use of indwelling ureteral stent, postoperative hospitalization, stone clearance rate, and perioperative complications were analyzed. No patient had associated morbidities that required any other additional procedure (pyeloureteral junction obstruction, urinary diversions, etc.). Results and Conclusions: Eighteen laparoscopic procedures were performed: nine ureterolithotomies, six cystolithotomies, and three pyelolithotomies. The mean age of the patients was 48 years (27–66 years), all were Caucasian subjects: 14 males and 4 females. No patient had acute renal failure. The mean serum creatinine value was 1.01 mg/dL (range: 0.8–2.5 mg/dL). Two patients presented a bilateral location of the stones. Stone position was as follows: nine ureteral (three proximal, two middle, and four distal), six in the bladder, and three in the renal pelvis. The mean operative time was ureteral stone, 82 ± 23 minutes; bladder stone, 47 ± 10 minutes; and kidney stone, 99 ± 26 minutes. Transfusion was not required in any patient, and the open conversion did not happen. The mean hospital stay was 3 days (2–4 days). The overall stone clearance rate was 88.9% (16/18), and two patients had residual kidney stones that were managed with extracorporeal SWL. At a mean follow-up of 6 months, no serious complications (bleeding, sepsis, bowel injury, ureteral strictures, or urinary leakage) occurred. Laparoscopic surgery is an effective and safe technique for the management of urinary tract stone disease, with a high stone clearance rate. Considering our case series and the literature,2,3 it might be considered an alternative second-line procedure in selected cases where other less invasive procedures (SWL, PNL, etc.) had failed. The authors declare that no competing financial interests exist. Runtime of video: 6 mins 47 secs