Abstract
ObjectiveTo compare the risk of postoperative ureteral stricture formation following retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL) in patients with proximal ureteral stones.Materials and MethodsWe retrospectively reviewed the medical records of patients who underwent RPLU or URSL for proximal ureteral stones between April 2011 and May 2015. Patients were allocated into URSL group or RPLU group and the outcomes were compared.ResultsA total of 201 patients who underwent 209 procedures including 159 URSL and 50 RPLU with a median follow-up of 30 months were included. No significant difference was observed among the two groups in most baseline parameters, while the stone size was significantly larger in the RPLU group (11.37 ± 2.97 vs 14.04 ± 4.38 mm, p = 0.000). Patients in RPLU group had markedly longer operative time (p = 0.000) and longer postoperative hospital stay (p = 0.000). The initial and one-month stone-free rates were significantly higher in the RPLU group (78.6% vs 100%, p = 0.000 and 82.4% vs 100%, p = 0.001, respectively). Patients in the RPLU had a higher complication rate (18.0% vs 9.4%, p = 0.098) and lower ureteral stricture rate (2.5% vs 2.0%, p = 1.000), while the difference was not significant. Further logistic regression model identified RPLU and female sex as independent risk factors for postoperative complication (Odds Ratio[OR] = 3.57, p = 0.035 and OR = 3.57, p = 0.025, respectively); however, URSL was not an independent risk factor for the formation of postoperative ureteral stricture after adjusting confounding variables (OR = 0.90, p = 0.935).ConclusionRPLU and URSL have similar postoperative ureteral stricture formation risks. RPLU can provide significantly higher stone clearance rate, but relates with more postoperative complications.
Highlights
Advances in minimally invasive endoscopic and laparoscopic techniques in the last few decades have remarkably changed the surgical management of ureteral stones
The primary aim of this study is to compare the risk of postoperative ureteral stricture formation in retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL)
No significant difference was observed among the two groups in age, gender, ASA grade, BMI, comorbidities, hydronephrosis status, urine culture, preoperative stenting, stone laterality, ipsilateral stone surgery history and stone history duration, while the stone size was significantly larger in the RPLU group (11.37 ± 2.97 vs 14.04 ± 4.38 mm, p = 0.000)
Summary
Advances in minimally invasive endoscopic and laparoscopic techniques in the last few decades have remarkably changed the surgical management of ureteral stones. Besides extracorporeal shock wave lithotripsy (ESWL), proximal ureteral stones can be managed by minimally invasive techniques like ureteroscopy, percutaneous nephrolithotomy and laparoscopic ureterolithotomy (Assimos et al, 2016; Turk et al, 2016) These treatment methods reach a high stone-free rate (SFR), many patients suffer from the formation of ureteral strictures after the removal of stones (Fam & Singam, 2015; Roberts et al, 1998). A recent randomized trial and meta-analysis showed that patients treated by the holmium: YAG laser have a significantly higher risk of postoperative stricture than those received pneumatic lithotripsy (Chen et al, 2017; Li et al, 2015) This was explained by the laser’s stronger ablation and coagulation effect which lead to stone fragmentation as well as ureteral thermal injury (Chen et al, 2017). The primary aim of this study is to compare the risk of postoperative ureteral stricture formation in retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL)
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