Laparoscopic ureterolithotomy versus ureteroscopic holmium laser lithotripsy for middle and upper ureteral stones

Abstract

Objective To explore the optimal surgical procedures and skills by comparing the efficacy of ureteroscopic holmium laser lithotripsy with that of laparoscopic ureterolithotomy for unilateral ureteral stones.Methods Sixty patients with unilateral ureteral stones were randomly assigned to receive laparoscopic ureterolithotomy under general anesthesia (n=30),or ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n＝30).Double-J stent was routinely placed in both groups.Surgical duration,length of hospital stay,stone clearance rate,and rate of perioperative complications were compared.Results Ureteroscopic holmium laser lithotripsy was successfully performed on 59 patients,and one patient needed to received open surgery intraoperatively.The mean surgical duration was (52.0 ± 10.7)min in ureteroscopic lithotripsy group and (68.6 ± 8.0)min in laparoscopic ureterolithotomy (P＜0.01); length of hospital stay was (3.8 ± 1.3)days and (4.7 ± 0.8)days (P＜0.01); and stone clearance rate was 87％ and 100％,respectively.In ureteroscopic lithotripsy group,stones moved to the renal pelvis in 4 patients,and the residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL).2 patients developed fever and recovered after anti-infective therapy.All patients were followed up for 6 to 24 months.Ureterostensis occurred in 2 patients during follow-up,and recovered after ureteroscopic urethrotomy was performed and 2 double-J catheters were placed for 3 months.Conclusions Laparoscopic ureterolithotomy has a higher stone clearance rate and fewer complications as compared with ureteroscopic holmium laser lithotripsy.Laparoscopic ureterolithotomy is a safe,effective procedure for ureteral stones. Key words: Ureteral stones; Ureteroscopy; Lithotripsy; Laparoscopy