Laparoscopic ureterolithotomy: bridging the gaps between open surgery and ureteroscopy and/or shock wave lithotripsy

Abstract

Background Ureteroscopic procedures together with shock wave lithotripsy are the standard of care for patients with symptomatic ureteral stones; in cases with large (>20 mm) and/or impacted stones, laparoscopic ureterolithotomy can be considered an alternative to open surgery, as it is less morbid with high stone-free rates. Patients and methods A retrospective study of patients enlisted for active ureteral stone treatment was conducted. Files of 945 patients were reviewed and analyzed in term of stone size, number, and history of previous stone procedures. A total of 73 patients were included; they had transperitoneal ureterolithotomy for either proximal or distal ureteral stone(s). Results Mean stone size was 31.7±8.5 mm, and median stone number was 1 (1–3). A total of 48 patients had proximal ureteric stones, whereas 25 had distal ones. Mean operative time was 96±19.2 min, stone-free rate was estimated to be 97%, and procedure was aborted in two patients. Complications were reported in 16%, with no grade 3 complications according to Clavian–Dindo classification. Mean hospital stay was 3.2±1.1 days. Conclusion Laparoscopic ureterolithotomy is to be considered for the treatment of large ureteric stone when other minimally invasive modalities are not available; it can bridge the gap between the minimally invasive procedures and conventional open surgery.