Retroperitoneal versus Transperitoneal Laparoscopic approach for Management of Upper Ureteric Stones

Abstract

Abstract Background Current options for ureteral stones include medical treatment, extracorporeal shockwave lithotripsy (SWL), and various endoscopic procedures, with the standard open ureterolithotomy being less frequently practiced nowadays. The use of laparoscopy in the management of ureteral stones was one of the earliest applications of laparoscopy in urology, the first report being made by Wickham in 1979. Objective To compare the laparoscopic Retroperitoneal ureterolithotomy with the Laparoscopic Transperitoneal ureterolithotomy as a better alternative to conventional open surgery to extract a large, impacted and hard stones at the proximal two thirds of the ureter. Methods In this study we present our experience with laparoscopic ureterolithotomy comparing both transperitoneal approach and retroperitoneal approach through a retrospective randomized comparative study that conducted on 50 patients admitted through the outpatient clinic of Urology in Ain shams University Hospitals and Nasser institute hospital. The 50 patients divided into two groups each one was 25 patients, first group was performed by the laparoscopic transperitoneal approach and the other group by the laparoscopic retroperitoneal approach Between October 2017 and October 2018. Results This study revealed that the length of the Hospitalization period and the duration of drainage and urethral catheter were shorter in the transperitoneal approach than in the retroperitoneal approach with statistical significance between the groups. In the present study, the mean time to oral intake was significantly shorter in the Retroperitoneal group than in the Transperitoneal group. This is due to the mobilization of the colon, dissection and retraction of the viscera, and blood and urine leak in the peritoneal cavity, causing intestinal movements and sounds to be more delayed in the LTU group. In contrast, the lost blood during the retroperitoneal procedure does not come into contact with the bowel, and if urine leakage occurs, it would be contained within the retroperitoneal space. Also we find that both approaches are safe with few complications that were significantly wider at the transperitoneal group; vascular injury didn’t occur at any of the cases with no need for blood transfusion. Conclusion Through our study we concluded that Laparoscopic ureterolithotomy is technically feasible and safe and both of its two approaches either transperitoneal or retroperitoneal are successful procedures with a success rate nearly the same in both techniques, but and based on our results through this study, we recommend the retroperitoneal approach for laparoscpic extraction of the ureteral stones due to the fact that it has the least operative time than the transperitoneal approach, getting rid of the all stone burden, lower rate of complications and a better postoperative recovery.