Laparoscopic ureterolithotomy for the management of distal ureteric giant calculi in the endourology era – case report & Brief review of literature

Abstract

Background: The novel concept of endourology was first introduced to the world in 1978 by three legendary doctors Elwin Fraley, Arthur Smith, and Paul Lange. Fast forward 40 years, endourology today mostly rules the overall management of the majority of urinary tract calculi with some rare exceptions. Large, giant, massive distal-impacted ureteric calculi seem to be one such subset of exceptional situation, where laparoscopic ureterolithotomy (LUL) may have an edge over endourological manipulation. Even though LUL is a well-recognized option, the usage of the same is declining ever since the advent of endourology and its advances. This article brings to light the importance of the role and relevance of LUL versus endourology for the management of select large, giant ureteric stones and aims to bring to light certain inherent combined advantages of LUL versus endourology, such as effectiveness, short learning curve, single-staged nature of procedure, and being minimally invasive. Case Presentation: A 30-years-old female presented to our clinic with complaints of right flank pain and recurrent episodes of Urinary tract infection for the past 4 months. Clinical evaluations/investigations revealed a large distal ureteric calculus with a poorly functioning right kidney without any underlying anatomic/metabolic abnormality. The patient underwent LUL with a modified three-port technique and a large stone of 3.5 × 2 cm was retrieved uneventfully with the placement of a Double J stent. Conclusion: LUL is the preferred therapeutic surgical management modality of choice for select uncomplicated giant/large ureteric calculi, as it is coupled with the dual advantage of being minimally invasive and is accompanied by complete clearance with minimal morbidity thereby acting as a bridge to combine the positives of both endourological and open procedures. We encourage researchers to consider LUL in the minimally invasive management of select large impacted distal ureteric calculi in the otherwise anatomically normal renal units.