Successful single-stage transperitoneal laparoscopic ureterolithotomy in a solitary functioning renal unit with multiple large ureteric calculi along its entire length

Sheshang U Kamath,Deepak Kaddu,Bhushan Patil,Sujata K Patwardhan

doi:10.1186/s12301-020-00029-6

Abstract

BackgroundLaparoscopic ureterolithotomy bridges the gap between open and endourologic procedures as it is minimally invasive and overcomes a few of the disadvantages of open ureterolithotomy. We report a case of a solitary functioning renal unit with at least 12 large ureteric calculi coursing along the entire length of the ureter and involving the renal pelvis presenting with obstructive uropathy which was subsequently successfully managed with laparoscopic ureterolithotomy.Case presentationA 50-year-old male patient presented with obstructive uropathy with CT suggestive of solitary functioning right kidney with right ureter showing at least 13 large ureteric calculi and large renal pelvic calculi. Right transperitoneal laparoscopic ureterolithotomy was performed. All the renal and ureteric calculi were successfully removed.ConclusionThus, laparoscopic ureterolithotomy with only three ports can be used to remove any burden of calculi along the course of the entire urinary tract being successful in a single stage with minimal morbidity.

Highlights

BackgroundIn the present endoscopic era, the indications for open surgery for stone disease range from 1.0 to 5.4% [1,2,3,4]
Laparoscopic ureterolithotomy bridges the gap between open and endourologic procedures as it is minimally invasive and overcomes a few of the disadvantages of open ureterolithotomy
Conclusion: laparoscopic ureterolithotomy with only three ports can be used to remove any burden of calculi along the course of the entire urinary tract being successful in a single stage with minimal morbidity

Summary

Background

In the present endoscopic era, the indications for open surgery for stone disease range from 1.0 to 5.4% [1,2,3,4]. A 5.0 × 2.5 cms sized calculus is noted in the right renal pelvis extending into the lower calyx. Few (5) 8–10-mm calculi are noted in the right renal calyces (Fig. 1). On reassessment after 5 days, the patient had a creatinine of 3.5 mg/dL and daily urine output from left PCN was 100 mL and from right was 1300 mL. After the urine culture was sterile, patient was posted for right transperitoneal laparoscopic ureterolithotomy. All stones were secured in a retrieval bag (Fig. 5) and removed outside through port-site incision. Drain was removed on post-operative day 3, per urethral catheter on day 4 and right PCN on day 7. Post-operative X-ray and USG revealed residual nonobstructive 8-mm calculi in right lower pole (Fig. 8). DJ stent was removed on post-operative day 21

Discussion

Conclusion