Retroperitoneal Laparoscopic Ureterolithotomy

Abstract

In current practice, most ureteral stones can be managed with endourology modalities including extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy or percutaneous nephrolithotomy [1]. However, in rare circumstances where the stones are large, impacted at the proximal or mid ureteral, and endoscopic modalities have failed, open surgery or laparoscopic ureterolithotomy is a feasible alternative to achieve better stone clearance rate [1–4]. Wickham firstly described laparoscopic ureterolithotomy in 1979 [5] and until 1992, Gaur described the new balloon dissection technique for retroperitoneal laparoscopic ureterolithotomy [6], it was recognized as a useful minimally invasive technique. In comparison to open surgery, the advantages of laparoscopic ureterolithotomy are less pain, shorter hospital stay, earlier mobilization and better cosmesis [3, 7]. Laparoscopic ureterolithotomy can be done via transperitoneal and retroperitoneal approach. Nonrandomized comparison of these two approaches failed to establish the superiority among each other in terms of treatment outcome [8]. Nonetheless, a prospective randomized controlled trial concluded that for proximal or mid ureteral large and impacted stones, transperitoneal laparoscopic ureterolithotomy is significantly associated with more pain, greater tramadol requirement, more ileus and longer hospital stay than retroperitoneal laparoscopic ureterolithotomy, with similar stone clearance rate as compared to retroperitoneal approach [9].