Transperitoneal Laparoscopic Ureterolithotomy Research Articles

Propensity score matched comparison of transperitoneal laparoscopic ureterolithotomy and percutaneous nephrolithotomy for management of large impacted proximal ureteral stones with long-term follow-up.

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4g/dL vs. 1.5 ± 0.7g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.

Comparison of laparoscopic ureterolithotomy, retrograde flexible ureteroscopy, and mini-percutaneous antegrade flexible ureteroscopic lithotripsy for treating large (≥ 15mm) impacted proximal ureteric stones: a prospective randomized trial.

The purpose of this study is to compare the outcomes of transperitoneal laparoscopic ureterolithotomy (TPLU), retrograde flexible ureteroscopy (R-fURS), and mini-percutaneous antegrade flexible ureteroscopy (A-fURS) for treating large (≥ 15mm) impacted proximal ureteral stones. A total of 105 adult patients were randomized into 3 equal groups: group A (35) patients underwent TPLU, group B (35) patients underwent R-fURS, and group C (35) patients underwent A-fURS. The initial stone-free rate was 100%, 68.6%, and 80% in groups A, B, and C, respectively. The mean operative time (OT) was (85.0 ± 7.57min) in group A, (61.0 ± 8.21min) in group B, and (89.57 ± 15.12min) in group C. The three groups were comparable concerning the overall complications. R-fURS is a less invasive modality for treating such stones; however, it is associated with a lower SFR and a higher rate of auxiliary procedures. Both TPLU and miniperc A-fURS are effective and valuable alternatives for treating large impacted proximal ureteric stones.

Laparoscopic transperitoneal ureterolithotomy is an effective and safe method for >15 mm impacted ureteral stones in elderly patients: single center 10-year experience.

The aim of our study is to investigate the efficacy and safety of laparoscopic ureterolithotomy operation in elderly patients with large and impacted ureteral stones. Between January 2011 and July 2021, 66 elderly patients with impacted, > 15 mm upper and middle ureteral stones underwent laparoscopic ureterolithotomy in our center. The data for all patients were evaluated retrospectively. The mean age of the patients was 65 ± 5.43 years. The mean stone size was 20.2 ± 2.5 mm. The mean operation time was 93.6 ± 13.2 minutes. Among patients, 16 (24.2%) had history of unsuccessful shock wave lithotripsy and 12 (18.1%) patients had history of ureterorenoscopy. Stone-free rate was 95.4% in all patients. Modified Clavien grade 1 complications were seen in 18 patients (27.2%), but no significant perioperative and postoperative complications were observed. Urinary extravasation lasting 5, 7 and 9 days was observed in 5 patients (7.5%) who were treated conservatively. The mean hospital stay was 3.4 ± 1.52 days. The patients were asymptomatic at the 6th week post-op follow-up, and no stones were seen on direct X-ray and abdominal ultrasonography. Intravenous urography and non-contrast tomography (NCCT) taken 3 months later did not show any obstruction or stenosis in the ureter. Laparoscopic ureterolithotomy can be considered as the first treatment option for elderly patients with impacted and large ureteral stones, thanks to its high success and acceptable complication rates.

PNEUMATIC URETEROSCOPIC LITHOTRIPSY VERSUS LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE UPPER URETERAL STONES- AN INITIAL EXPERIENCE.

Objective: The treatment of choice for large upper ureteral stones is controversial. In the developing nations, semi rigid ureteroscopy is the preferred treatment modality for ureteric stones even in upper ureter. However, Laparoscopic ureterolithotomy has started gaining acceptance for the treatment of large proximal ureteral stones. This study was done to compare solely the outcomes of semi-rigid pneumatic ureterolithotripsy (URSL) and transperitoneal laparoscopic ureterolithotomy (LU) for large upper ureteric stones. Methods: In all, 30 patients who met the inclusion criteria were randomised into 2 groups: URSLand LU. The groups were compared for stone clearance rate, operative time, complication rates.Results: LU had signicantly higher stone clearance rate both at discharge (p=0.014) and at 3 weeks post operatively (p = 0.033) than URSL. On the other hand, URSLhad signicantly shorter mean operating time (p<0.0001), length of hospital stay (p=0.0013) and required less auxiliary procedures than LU group. No major complications were observed and the complication rate was not statistically signicant among the groups (p=0.41).Conclusion: Laparoscopic ureterolithotomy was associated with higher stone clearance rate but with longer hospital stay and operative time than URSL, however the complications were similar. Consequently, the procedure of choice for large proximal ureteric calculi should be based on the expertise of the surgeon, patient's choice and the availability of equipments.

Comparative Study of Transperitoneal Laparoscopic Versus Retroperitoneoscopic Ureterolithotomy Techniques

Purpose: This study evaluated the effectiveness and safety of transperitoneal laparoscopic ureterolithotomy (TPLU) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the surgical management of ureterolithiasis. Materials and Methods: The current prospective study was conducted at the Department of Urology, Dr. D. Y. Patil Medical College. The complete patient medical history including patient's age, sex, stone (size, number, and laterality), and past history of stone surgeries were evaluated. Based on the treatment method, the patients were divided into TPLU and RPLU group. Both the procedures were evaluated for parameters including operative technique, operating time, hospital stay, intra- and postoperative complications, conversion rate, success rate, and surgical ergonomics. Results: A total of 50 patients were included (TPLU, n = 25; and RPLU, n = 25). The average age was 43.6 years in the TPLU and 46.7 years in the RPLU group. The average size of calculi was >15 mm in both the groups. The operation time and blood loss were relatively higher in the TPLU group than RPLU group. The complete stone clearance was observed in both the groups. The pain in loin area and burning micturition were the most common complaints reported by the patients from both the groups. One patient from RPLU group was converted to open surgery. The calculi size in TPLU group was positively correlated with operative time (r = 0.535, P = 0.006), blood loss (r = 0.440, P = 0.028), and hospital stay (r = 0.430, P = 0.032). Conclusion: TPLU and RPLU are feasible techniques for the management of large ureteric stones that are not amenable to ureteroscopy or extracorporeal shockwave therapy.

Outcome of Transperitoneal Laparoscopic Ureterolithotomy (TPLU) for proximal ureteral stone > 15 mm: Our experience with 60 cases.

We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.

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

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.

Retroperitoneal versus Transperitoneal Laparoscopic approach for Management of Upper Ureteric Stones

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.

Impacted Mid Ureteric Stone: Comparative Study of Treatment by Transperitoneal Laparoscopic Ureterolithotomy versus Ureteroscopy

Impacted Mid Ureteric Stone: Comparative Study of Treatment by Transperitoneal Laparoscopic Ureterolithotomy versus Ureteroscopy

A Prospective Randomized Study of Large Proximal Ureteral Stones: Uretero-lithotripsy v/s Laparoscopy

Background Upper one third ureteric stones has plethora of treatment, choice being medical expulsive therapy, shock wave lithotripsy (SWL), ureteroscopy (URS), laparoscopic and open ureterolithotomy. With the advent of newer generation lithotripters, flexible ureteroscopes and miniature semi-rigid ureteroscopy, most of the upper ureteral stones can be managed with a minimally invasive approach. However, large ureteral stones are a challenge to minimally invasive techniques. The optimal management of large proximal ureteral stones (&gt;15mm) is still to be defined. Method A total of 39 cases of large proximal ureteral stones (&gt;15mm) were included in this prospective study. All patients were randomly divided in to two groups: Ureterolithotripsy with Pneumatic lithotripter (URS-P)-21 cases and Transperitoneal Laparoscopic Ureterolithotomy (LAP-TPUL)-18 cases. Results Mean stone size was 16.79±1.51and 17.14±1.96 in URS-P and TPUL respectively. The overall stone-free rate was 13/21(61.9%) for URS-P versus (17/18) 94.4% for TPUL. Auxiliary procedure rate was higher in URS-P than in TPUL (38% vs. 5.6% respectively). The complication rate was 22.2% in TPUL versus 23.8% in URS-P. Mean procedure time was higher in Lap-TPUL group as compared to URS group (84.07±16.80 vs 65.17±12.78 minutes). Hospital stay was 4.16±0.67 days in Lap TPUL group and 1.32±0.43 days in URS group (p&lt;0.0001). Conclusion For large proximal ureteral stones of size greater than 15mm, Laparoscopic Ureterolithotomy has a greater stone clearance rate, lesser need for auxiliary procedure, less complication rate but higher procedure time and hospital stay as compared to URS. We strongly recommend Laparoscopic ureterolithotomy for large proximal ureteral stones.

Laparoscopic Ureterolithotomy vs Ureteroscopic Lithotripsy for Large Ureteral Stones

Background and Objectives:The purpose of this study was to compare two methods (transperitoneal laparoscopic ureterolithotomy [TLU] and a combination of ureteroscopic lithotripsy [UL] with retrograde intrarenal surgery [RIRS]) designed for the treatment of large proximal ureteral calculi so that their associated complications and stone-free rates could be assessed.Methods:A total of 100 patients from three different hospitals who were diagnosed with large upper ureteral stones (≥15 mm) were treated via TLU (n = 48) or UL-RIRS (n = 52). They were treated between March 2012 and May 2014. The study compared the complications, success rate, patient characteristics, and the operation time between the two groups.Results:The immediate stone clearance rate after a single session was higher in the TLU group than in the UL-RIRS group (100% vs 73.1%, P = .005). However, there was no significant difference in the stone-free rates between the two groups three months after the last procedure was performed (100% vs 96.1%, P = .655). Regarding patients with a history of early-failure extracorporeal shock-wave lithotripsy, there was no significant difference in the stone-free rate between the two groups three months after the last procedure (100% vs 94.4%, P > .05). Further, overall complication rates between the groups were not statistically different (P = .261).Conclusion:This study demonstrates that TLU is an effective and safe procedure to treat large impacted upper ureteral stones. When compared to UL-RIRS, TLU showed equivalent efficacy and safety, though there were failed first-line treatments.

Outcome of Laparoscopic Transperitoneal Ureterolithotomy for Proximal Ureteric Stones - Our Two Years Experiences

To evaluate the results of laparoscopic transperitoneal uteterolithotomy for management of large proximal ureteric stones. This study was performed on 24 patients having proximal ureteric stone greater than 1.5cm at the Department of Urology, Shahid Sheik Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2016 to December 2017. Patients having stone size less than 1.5cm, previous abdominal surgery and sepsis were excluded from this study. Patients characteristics, stone characteristics, perioperative and follow-up data were studied. Twenty-four patients (mean age=52.9±12 years) with large upper ureteric stones (mean stone diameter=35±12) were included. Twenty-two patients had single stone and 2 patients had two stones. Mean operative time was 107±49.5 min with mean blood loss of 60.5±19.2 cc. Mean total pain score was 38.4±5.5 (100 point scale) and mean time resuming oral intake was 7.2±1 h. Mean duration of hospital stay was 2.6±1.4 days and mean time of stenting was 7.2±2 weeks. Throughout a mean duration of follow-up of 10.8±6.6 months 100% stone clearance rate was achieved with no recurrence. Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain short hospital stays and cost effective and should be considered as a choice of treatment option for such stones.Medicine Today 2018 Vol.30(2): 71-73

417 - Transperitoneal laparoscopic ureterolithotomy vs. percutaneous antegrade ureteroscopy in the treatment of large proximal ureteral calculi: A prospective randomized comparative study

417 - Transperitoneal laparoscopic ureterolithotomy vs. percutaneous antegrade ureteroscopy in the treatment of large proximal ureteral calculi: A prospective randomized comparative study

Laparoscopic Ureterolithotomy in Children: With and Without Stent - Initial Tertiary Care Center Experience with More Than 1-Year Follow-Up.

Background The purpose of our study was to assess the safety and feasibility of transperitoneal laparoscopic ureterolithotomy (LU) in children with ureteric stones with and without a stent. Method Impacted ureteric stone of size ≥ 1.5 cm or ureteric stones that were refractory to shock wave lithotripsy (SWL)/ureteroscopy (URS) were considered for LU. From December 2009 to April 2012, 50 cases of LU were performed with a stent being placed. From May 2012 onward we now perform stentless LU and till now we have done approximately 64 such type of cases. Out of these, 48 have completed more than 1 year of follow-up and we took these as our study group and the previous 50 (LU with stent) as our control group. Baseline characteristics along with certain per- and postoperative findings of the two groups were noted and analyzed. Ultrasonography and X-ray kidney, ureter, and bladder region were done at 3, 9 months, 1 year, and yearly thereafter. Intravenous urography was done at 6 months statistical analysis was performed by using SPSS ver. 21 (SPSS Inc., Chicago, Illinois, United States). The data were analyzed by using the Mann-Whitney test and a p value of < 0.05 was considered significant. Results The baseline characteristics were similar in both the groups with 100% stone clearance in all. LU with stent differed from the stentless group in terms of more requirement of analgesics and the need for a second procedure for stent removal, but with no cases of urine leak in the postoperative period. Conclusion LU in children is a safe and viable option, especially for impacted stones or as a salvage procedure for ureteric stones when SWL or transureteral lithotripsy has failed.

Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis.

Objective:To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones.Methods:A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group.Results:It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001).Conclusions:The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities.

Large proximal ureteral stones: Ideal treatment modality?

Background and Purpose:Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety.Patients and Methods:From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL).Results:The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001).Conclusion:Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery.

79 Comparative outcomes flexible ureteroscopy versus transperitoneal laparoscopic ureterolithotomy for the treatment of proximal ureteral stones >15 mm in patients who initially presented with urosepsis

79 Comparative outcomes flexible ureteroscopy versus transperitoneal laparoscopic ureterolithotomy for the treatment of proximal ureteral stones >15 mm in patients who initially presented with urosepsis

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed. There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.

RETROPERITONEAL VS TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY

Objective: To compare retroperitoneal versus transperitoneal laparoscopic ureterolithotomy in effectivity, pain scale and early complications. Material &amp; methods: In this prospective comparison study from January 2013 to June 2014, 32 patients with proximal and mid ureteral stones underwent retroperitoneal laparoscopic ureterolithotomy or transperitoneal laparoscopic ureterolithotomy. The randomization occured on consecutive sampling on a 1 : 1 basis. Group 1 and 2 consisted of patients who underwent retroperitoneal laparoscopic ureterolithotomy and transperitoneal laparoscopic ureterolithotomy, respectively. Demographic and clinical variable, operative time, length of stay, ureteral suturing, pain scale according to visual analog scale (VAS) and early complications data were collected and analyzed. Statistical analysis was performed with SPSS® version 17.0 using student T-test and Mann-Whitney U tests with p value &lt; 0.05 considered statistically significant. Results:VAS on day 1 between the 2 groups was statistically significant, and was higher in group 2 (p &lt; 0.05). According to the Clavien-Dindo classification of surgical complication all the patients were in grade 1 classification. The differences in operative time, length of stay, ureteral suturing, visual pain analog score on day 3, and early complications between the 2 groups were not statistically significant.Conclusion: Transperitoneal laparoscopic ureterolithotomy is significantly associated with pain than retroperitoneal laparoscopic ureterolithotomy in first day after surgery. Successful stone removal remains the same in both groups.

TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE DISTAL URETERIC STONE

Objective: This study is aim to share our experience (in videos) in Laparoscopic ureterolithotomy for large distal ureteric stone with transperitoneal approach. Material &amp; methods: A 37 years old male has been diagnosed with a right hydronephrosis due to proximal ureterolithiasis and stone at left calyx inferior, first and stone migrated to right distal ureter on 12 hours prior surgery, in Hasan Sadikin Hospital Bandung. He underwent laparoscopic ureterolithotomy with transperitoneal approach. Results: We successfully perform laparoscopic ureterolithotomy with transperitoneal approach on a 37 years old male patient who diagnosed with a right hydronephrosis due to distal ureterolithiasis and stone at left calyx inferior. Duration of operation was 45 minutes. Patient was discharged at 2nd postoperative day without any complications. Conclusion: A transperitoneal laparoscopic ureterolithotomy for distal ureteric stone is a safe and feasible technique that should be an options on every patients who is planning to undergo distal ureterolithotomy especially large stone.&#x0D; Keywords: Transperitoneal, laparoscopy, distal ureterolithotomy.