Laparoscopic Ureterolithotomy Research Articles

Applying Bulldog Clamps to Prevent Stone Migration in Laparoscopic Upper Ureteral Stone Surgery

Background: Urolithiasis can be managed by endoscopic, laparoscopic, percutaneous, or open approaches. We introduce an effective and safe method for stone migration during laparoscopic ureterolithotomy. Description of Technique: We used laparoscopic intraperitoneal approach, with three ports. Stone is localized and the ureter occluded proximally and distally to the stone using bulldog clamps to minimize the risk of stone migration. Patients and Methods: Case 1 had a 15 mm left upper ureteral stone — refractory to ESWL. Case 2 had a 17mm right upper ureteral stone without previous stone procedure. Case 3 had a history of failed ESWL for a 17mm left upper ureteral stone. Results: Mean operation time was 55 minutes, mean hospital stay was two days, and SFR was 100%. No complications occurred during this minimally invasive surgery, either intra-operatively or post-operatively. Conclusion: This is a safe and effective maneuver, increasing the stone-free rate of the procedure, which facilitates stone surgery by releasing the surgeon’s hands and preventing stone migration.

The optimal management of large upper ureteral stones (> 1.5 cm) with infection in elderly patients: a comparative analysis of three minimally invasive surgical approaches.

The aim of this study was to investigate the efficacy and safety of three minimally invasive surgical approaches for treating large upper ureteral stones complicated by infection in elderly (> 60years) patients. Clinical data from 95 elderly patients with large upper ureteral stones and infection, treated at our hospital between January 2018 and April 2023, were retrospectively analyzed. The surgical approaches included FURL (flexible ureteroscopic lithotripsy) 33 cases, mPCNL (minimally percutaneous nephrolithotomy) 29 cases, and RLUL (retroperitoneal laparoscopic ureterolithotomy) 33 cases. Surgical time, intraoperative blood loss, postoperative hospital stay, reoperation rate, incidence of postoperative complications, and hospitalization costs were observed and compared among the three groups. No statistically significant difference was found in stone clearance rates among the three groups (P > 0.05). The FURL group exhibited advantages over the mPCNL and RLUL groups in surgical time, intraoperative blood loss, and postoperative hospital stay (P < 0.05). However, it also had the highest reoperation rate and hospitalization costs (P < 0.05). RLUL demonstrated superiority over the mPCNL and RLUL groups in terms of reoperation rate, incidence of complications, and hospitalization costs (P < 0.05). Notably, mPCNL exhibited the highest complication rate at 37.9% (P < 0.05). For elderly patients with large upper ureteral stones complicated by infection, FURL, mPCNL, and RLUL represent effective surgical approaches. Further attention is needed regarding the perioperative safety of mPCNL. RLUL, which offers higher safety, efficacy, and cost-effectiveness, can be considered a primary surgical option for these patients.

Ureteroscopy vs laparoscopic ureterolithotomy for large proximal ureteric stone: a randomised trial.

To compare the outcomes of retrograde flexible ureteroscopy (fURS) with retroperitoneal laparoscopic ureterolithotomy (RLU) for large proximal ureteric stones. A prospective randomised trial was conducted from January 2018 through December 2022 including patients with impacted proximal ureteric stones of 15-25 mm. Patients underwent fURS or RLU. Primary outcome was the stone-free rate. Demographic data, stone features, and complications rates were also compared between groups. A total of 64 patients were enrolled, 32 in each group. The mean impacted stone time was similar between groups, as well as stone size (17 mm) and stone density (>1000 Hounsfield Units). The ureteric stone-free rates between the two groups (93.7% in fURS vs 96.8% in RLU; odds ratio [OR] 0.72, 95% confidence interval [CI] -1.72 to 3.17; P = 0.554), and overall success rates, which take into account residual fragments in the kidney (84.3% in fURS vs 93.7% in RLU; OR 1.02, 95% CI -0.69 to 2.74; P = 0.23), were similar. Operative time was also not statistically significantly different between groups (median 80 vs 82 min; P = 0.101). There was no difference in hospital length of stay. Retropulsion rate was higher with fURS (65.6% vs 3.1%; p < 0.001). Residual hydronephrosis (34.3% each group) and complication rates did no differ according to treatment. Flexible URS and RLU are both highly efficient and present low morbidity for large impacted proximal ureteric stone treatment. RLU is not superior to fURS.

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.

Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy in the Management of upper Ureteric Stones Measuring from One to Two Centimeters: Randomized Prospective Study

Abstract Objective This prospective study aims to compare the clinical efficacy and safety of flexible ureteroscopy versus laparoscopic ureterolithotomy in the management of upper ureteric stones measuring from one to two centimeters. Methods his randomized-prospective study was conducted on 64 patients admitted from Urology unit, Ain Shams University in the period from October 2020 till September 2022; only 56 patients were analyzed statistically and 8 patients were excluded due to shortage in post- operative data and follow up. Patients were divided into two groups Group A consists of 31 patients and Group B consists of 25 patients with matched age, gender and body mass index (BMI). Results In our study, The VAS score at 6 hours post-operative and day 1 post-operative was found to be 5.32 and 2.71 in FURS group and was found to be 7.28 and 3.28 in RPLU group respectively showing significant difference with (p- value &amp;lt;0.001 and 0.016 respectively) between the two groups with more satisfaction in FURS group mostly due to the absence of trocars incisions. The complications were classified according to modified Clavien classification system. No major complications such as septic shock or death were reported in either treatment groups. As regards the recovery to work in postoperative and follow up periods in the present study, there was a significant difference between both groups with (P-value &amp;lt;0.001), as we found that it takes about 4.56 ± 0.82 days in RPLU group and 3.06 ± 1.91 days in FURS group to return daily routine activities. As regards the stone free rate in follow up periods in the present study, there was a significant difference between both groups with (P-value 0,02), as we found that it was 100% and 80,6% in RPLU and FURS group respectively. Our success rate in RPLU group was found to be 100% in comparison to Irfan Nazir Mir et al which was 93.4% (28/30) with two patients (2/30) converted to open ureterolithotomy, either due to technical snag or due to difficulty in localizing the ureter laparoscopically. Conclusion Both F-URS and RTLU were safe and effective surgical procedures for treatment of large proximal ureteral stones. However, RTLU had a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. Also as regards to postoperative pain, shorter hospital stay and faster return to daily activities, both have almost similar results.

COMPARISON OF SUCCESS OF EXTRACORPOREAL LITHOTRIPSY (ESWL) AND LASER URETERORENOSCOPY IN PROXIMAL URETERIC STONES

Managing ureteral stones to achieve complete stone clearance with minimal patient morbidity involves several therapeutic approaches. The commonly used methods include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy. However, definitive evidence-based options for managing large proximal ureteral stones are lacking. Objective: To compare extracorporeal shock wave lithotripsy (ESWL) and laser ureterorenoscopy (URS) success rates in treating proximal ureteric stones. Methods: This randomized controlled trial was conducted in the Department of Urology &amp; Renal Transplantation at Bahawal Victoria Hospital, Bahawalpur, from January 1, 2020, to May 31, 2021. One hundred four patients, aged 20 to 60, with single proximal ureteric stones measuring 8-15 mm, were included. Patients with pyonephrosis, sepsis, bleeding disorders, solitary kidney, previous open ureterolithotomy, chronic renal failure, proteinuria, recurrent urinary tract infections, congenital urinary tract obstruction, bladder outflow obstruction, chronic liver disease, or a history of chronic drug usage were excluded. Patients were randomized into two groups: Group A underwent URS lithotripsy with DJ stent placement, while Group B underwent ESWL with DJ stent placement. A single surgeon performed all procedures. Pre-operative antibiotics and analgesics were administered to all patients. Stone clearance was assessed two weeks post-procedure. Statistical analysis was performed using appropriate methods, with a p-value ≤ 0.05 considered significant. Results: The mean age of patients in Group A was 37.52 ± 11.20 years, and in Group B was 36.73 ± 10.57 years. Most patients (75, 72.12%) were between 20 and 40. Out of the 104 patients, 63 (60.58%) were male, and 41 (39.42%) were female, with a male-to-female ratio of 1.7:1. Complete stone clearance was achieved in 44 (84.62%) patients in Group A (URS group) and 30 (57.69%) patients in Group B (ESWL group), with a statistically significant p-value of 0.002. The study concluded that the stone clearance rate after laser ureterorenoscopy (URS) is significantly higher than extracorporeal shock wave lithotripsy (ESWL) for proximal ureteric stones.

Robotic Ureterolithotomy for Retained Stent With Massive Encrustation: Case Report and Review of the Literature

Massive encrustation is a rare complication of retained foreign bodies in the urinary tract. Large stone size and coexisting artificial material can limit endoscopic options, necessitating surgical removal. We present a case of massive encrustation of a retained ureteral stent treated with robotic-assisted laparoscopic ureterolithotomy.

Comparison of efficacy and safety of open and laparoscopic proximal ureterolithotomy for ureteral stone management: A systematic review and meta-analysis.

Despite advances in non-invasive and minimally invasive techniques, some proximal ureteral stones with impaction require open or laparoscopic surgery. No systematic reviews or meta-analyses have compared the efficacy and safety of open proximal ureterolithotomy and laparoscopic approaches. The aim of this study was to compare the efficacy and safety between open and laparoscopic proximal ureterolithotomy for ureteral stone management. Following the PRISMA guidelines, systematic searches were conducted in five databases (PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest) to identify articles comparing those two surgical approaches. Operative time, blood loss, pain score, hospital stay, recovery time, and complications were collected and compared. Heterogeneity-based meta-analysis with random-effects or fixed-effects models were conducted. Two randomized controlled trials and four observational cohort studies with 386 participants met the criteria. Open surgery had significantly less time than laparoscopic ureterolithotomy (mean difference (MD): 26.63 minutes, 95%CI: 14.32, 38.94; p<0.0001). Intraoperative blood loss (MD: -1.27 ml; 95%CI: -6.64, 4.09; p=0.64) and overall complications (OR: 0.68; 95%CI: 0.41, 1.15; p=0.16) were not significantly different between two approaches. Laparoscopic ureterolithotomy reduced visual analogue scale (VAS) pain scores (MD: -2.53; 95%CI: -3.47, -2.03; p<0.00001), hospital stays (MD: -2.40 days; 95%CI: -3.42 to -1.38 days; p=0.03), and recovery time (MD: -9.67 days; 95%CI: -10.81 to -8.53 days; p<0.00001). In conclusion, open proximal ureterolithotomy had less time, but laparoscopic surgery reduced postoperative pain, hospital stay, and recovery time. Both methods had comparable intraoperative bleeding and complications.

Efficacy and Safety of Treatment Options for Large Upper Ureteral Stone

Background: There are three minimally invasive methods for the treatment of large (&gt;1 cm) upper ureteral stones: ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LUL). With multiple surgical options, the controversy of choosing the best option for a given patient lies. Objective: To compare efficacy and safety between URSL, PCNL and LUL to determine the best choice. Methodology: This study was conducted from March 2020 to February 2022 with 120 patients who had upper ureteral stones admitted at NIKDU. They were randomized into 3 equal URSL, PCNL &amp; LUL groups, 40 patients in each group. The primary outcome was a stone-free rate after 1 month of surgery, and the secondary outcomes were the duration of surgery, length of hospital stay, and complication rate postoperatively. Result: Eight patients needed auxiliary PCNL after URSL and 1 patient after LUL, but none after PCNL. The stone-free rate was 78.1% (25/32) in the URSL group, 95% (38/ 40) in the PCNL group and 100% (39/39) in the LUL group. Operation time was the shortest with URSL and the longest with LUL (all p &lt;0.05). Hospital stay was shorter in the URSL group compared with PCNL &amp; LUL group (p=0.0001). Operation-related complications were almost similar among the three groups. Conclusion: Laparoscopic ureterolithotomy followed by PCNL is the most efficacious modality for treating large upper ureteral stones with a superior stone-free rate and lesser need for auxiliary treatments compared to URSL. Bangladesh J. Urol. 2022; 25(2): 93-97

Retroperitoneoscopic Ureterolithotomy for the Management of Proximal Ureteric Stones: Initial Clinical Experience

Objective: Laparoscopic ureterolithotomy provides results equivalent to open ureterolithotomy for proximal ureteric stones, can be performed transperitoneally and retroperitoneally. The study aims to assess the efficacy of retroperitoneoscopic ureterolithotomy for managing proximal ureteral stones. Patients and Methods: It was a retrospective study carried out in the period from March 2018 to November 2021. 14 patients with proximal ureteric stones 16–26 mm (20.07± 02.8), all located above the upper border of the sacroiliac joint. Eleven (78.57%) patients underwent retroperitoneoscopy as a primary procedure, one (07.14%) had a history of failed ESWL, and two patients (14.28%) failed retrograde ureteroscopy. Retroperitoneoscopic ureterolithotomy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital and homemade balloon dissection and secured 10 mm Hasson trocar at the primary port site, and 0° telescope advanced. Two 5-mm trocars were placed under visualization forming a triangle. The stone was removed from the primary port site while visualizing retrieval through the 5 mm. port using a fine 30° Cystoscope. Ureterotomy closure was performed by intracorporeal interrupted sutures of 4-0 polyglactin over 5 fr double-J stent, and a drain was left in the retroperitoneum. Results: Retroperitoneoscopic ureterolithotomy was accomplished in 11 out of 14 cases (78.58%). Three (21.42%) were converted to open surgery (2) and transperitoneal ureterolithotomy (1). The reason for open conversion was the failure to locate the ureter due to severe adhesion in 1 case, technical problems during dissection in 1 case, and another access problem, injury to the peritoneum, which was converted to the transperitoneal route. In 11 successful cases, the mean operative time was 126.5 ± 23.81 (90-170) min. There was no requirement for transfusions. There were no major perioperative and post-operative complications were observed. According to the modified Clavien classification, 07(63.63%) patients were reported to be grade I, whereas 04(36.36%) patients were reported to be grade II. One patient was managed with a course of antibiotics due to post-operative fever. Two patients who developed subcutaneous emphysema and superficial wound infection were treated conservatively. One urinary leakage was subsided by urethral re-catheterization. The drain was removed at 03.81 ±01.25(03-07) days. The mean hospital stay was 04.09 ± 01.13 (03-07) days. Conclusion: Retroperitoneoscopic ureterolithotomy has acceptable overall complication rates. It is an effective, low-morbidity alternative for the treatment of proximal ureter stones. Bangladesh J. Urol. 2022; 25(2): 84-92

The Outcome of Laparoscopic Ureterolithotomy-the Initial Experience in a Divisional Level Tertiary Hospital

Objectives : To see the outcome of laparoscopic ureterolithotomy as a beginner Methodology: This was an observational study that was conducted in the Department of Urology, Rangpur medical college from the period from January 2019 to June 2021. The patient’s ages range from 20 years to 60 years. The patients were selected from those with urinary stone disease and were admitted in the urology department. Those with large impacted stones in the ureter with good renal and cardiac functional status were selected. Laparoscopic ureterolithotomy via transperitoneal approach was performed in every case under general anesthesia. DJ stent was given in every case, and the ureterotomy wound was closed with 4-0 round body vicryl. All patients were mobilized and returned to oral feeding on the morning of 1st postoperative day. The catheter was removed on 2nd postoperative day, and the drain was removed on the third postoperative day if the drainage level fell below 50 mL. The D-J catheter was removed under local anesthesia between the second and fourth postoperative weeks. Complications were classified according to the modified Clavien classification system [12]. All patients were given follow-up for 3 months. IVU was done in every case to evaluate stricture at 3rd month of follow-up. The data were recorded and analyzed with Microsoft excel software 2021. Result : Total 25 cases were recorded. The mean patient age was 39.3± 5.9 years. There were 16 male (63.3%) male and 9 (26.7%) female patients in the study. Stones were located on the right side in 17 (62.9%) patients and on the left side in 8 (37.1%) patients. The size of the stones varied from 12 to 19 mm, and the mean stone size was 15 ±2.5 mm. The mean operative time was 125± 8.9 minutes. Intraoperative insertion of the D-J stent was performed in all patients. The D-J catheter was removed under local anesthesia between the second and fourth postoperative weeks. Complications were classified according to the modified Clavien classification system [12]. Conclusion : Laparoscopic ureterolithotomy can be considered an intermediate step in gaining experience and developing the necessary skills in utilizing the laparoscopic approach in more complicated reconstructive or radical urological surgery. As a beginner in laparoscopic procedure, the outcome of this laparoscopic ureterolithotomy in our unit is satisfactory, and patient compliance is very good. Bangladesh J. Urol. 2022; 25(1): 37-44

Comparison of outcomes between laparoscopic ureterolithotomy and push back PCNL in the management of upper ureteric stone

Background: Upper ureteral stones are a common issue. There are numerous treatment options available, including medical expulsive therapy, shockwave lithotripsy, ureteroscopic stone extraction, PCNL and laparoscopic ureterolithotomy. PCNL and laparoscopic ureterolithotomy are the main approaches for large upper ureteral stones. Objective: To compare the outcome between laparoscopic ureterolithotomy and push back PCNL in the management of upper ureteric stone Methods: In this prospective study 60 patients presenting with upper ureteric stone were selected. Patients with renal insufficiency (creatinine &gt;2.5 mg/dL), morbid obesity, coagulopathy, concurrent renal and ureteric stones, pregnancy, sepsis, stone size more than 30 mm, orthopedic contraindications for prone position and those with a probability of inability to achieve safe access to the collecting system on pre-operative imaging were excluded from this study. Upper ureteric stones were removed from 30 patients by laparoscopic ureterolithotomy and by push back PCNL procedure from another 30 patient stones. Two procedures were compared based on stone clearance rate, complications, surgery time and postoperative hospital stay. Results: The mean age of the laparoscopic ureterolithotomy group in this study was 41.83 ± 7.96 years and in push back PCNL group it was 42.23 ± 7.42 years (p = 0.841). Male patients were predominant than female patients in each group. Mean stone diameter of laparoscopic ureterolithotomy group was 22.90 ± 4.18 mm and in push back PCNL group it was 21.26 ± 3.85 mm (p=0.122). Mean operative time of laparoscopic ureterolithotromy patients was 1.42 ± 0.14 hours and in push back PCNL group it was 1.19 ± 0.09 hours, the difference between the procedures was statistically significant (p&lt;0.001). In laparoscopic ureterolithotomy group postoperative prolonged urine leakage was found in 4 (13.3%) cases and postoperative fever in 1 (3.3%) case. Postoperative analgesic required in 6 (20.0%) cases in laparoscopic ureterolithotomy group and 7 (23.3%) cases in push back PCNL group. Transfusion required only in push back PCNL group (13.3%). Duration of post-operative hospital stay was significantly higher in laparoscopic ureterolithotromy group than push back PCNL group. In this study, stone clearance rate was 100.0% &amp; 100.0% in both the groups. Conclusion: Both laparoscopic ureterolithotomy and push back PCNL are similar in management of upper ureteric stone. Bangladesh J. Urol. 2022; 25(1): 14-18

A Novel Technique of Management of Impacted VUJ Calculus: Laparoscopic Ureterotomy

The incidence of urolithiasis in the pediatric population is on the rise. Endoscopic lithotripsy has become a technique of choice for the treatment of ureteral stones in children. Laparoscopic ureterolithotomy is a minimally invasive option for ureteric stones that are not amenable to ureteroscopy. We present a case of 7 years girl with right impacted vesicoureteric junction (VUJ) calculus with bullous cystitis managed innovatively with laparoscopic ureterotomy.

Outcome of Laparoscopic Ureterolithotomy in Comparison to Open Ureterolithotomy for the Treatment of Large and Impacted Upper Ureteric Stone

Background: Ureteric stones are a common clinical issue, often necessitating open ureterolithotomy for large and impacted upper ureteric stones. Despite its success, laparoscopic surgery has gained popularity as an alternative approach, offering potential benefits such as reduced morbidity and shorter hospital stays. This study aims to compare the outcomes of laparoscopic ureterolithotomy with open ureterolithotomy for large impacted stones in the upper ureter. Methods: A prospective quasi-experimental study was conducted from June 2018 to August 2019 at the Department of Urology, Dhaka Medical College Hospital. The study enrolled sixty patients with upper ureteric stones larger than 2 cm. Patients were divided into two groups: Group A underwent laparoscopic ureterolithotomy, while Group B underwent open ureterolithotomy. Demographic data, medical history, examination findings, and investigation reports were recorded for all patients. Post-surgical pain scores, blood loss, complications, and hospital stays were also evaluated. Results: The study compared the outcomes of Group-A and Group-B patients who underwent ureterolithotomy. Group-A had an average age of 49.66 ± 14.70 years, while Group-B's average age was 51.60 ± 11.93 years. There was no significant difference in gender distribution between the groups (p-value 0.371). Group-A had a mean operative time of 2.11 ± 0.41 hours, while Group-B had a mean operative time of 1.60 ± 0.28 hours. Laparoscopic ureterolithotomy resulted in significantly less blood loss (p-value &lt;0.001). Group-A had a lower mean pain score (59.27 ± 8.56) compared to Group-B (75.50 ± 17.34). Laparoscopic ureterolithotomy also required less Pethidine (p-value &lt;0.001). Group-A experienced 6.7% wound infection and 10% UTI, while Group-B had higher rates (26.7% and 33.3% respectively). Urine extravasation occurred in 16.7% of Group-A, on the hand, in Group-B, it was 6.7%. Group-A had a shorter hospital stay (4.17 ± 1.18 days) compared to ........

V01-12 ROBOTIC URETEROLITHOTOMY FOR RETAINED STENT WITH MASSIVE ENCRUSTATION: CASE REPORT AND REVIEW OF THE LITERATURE

You have accessJournal of UrologyCME1 Apr 2023V01-12 ROBOTIC URETEROLITHOTOMY FOR RETAINED STENT WITH MASSIVE ENCRUSTATION: CASE REPORT AND REVIEW OF THE LITERATURE Lily Kong, Nathaniel Coddington, Gary Shahinyan, and Brian Flynn Lily KongLily Kong More articles by this author , Nathaniel CoddingtonNathaniel Coddington More articles by this author , Gary ShahinyanGary Shahinyan More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Massive encrustation is a rare complication of retained foreign bodies in the urinary tract. Large stone size and coexisting artificial material can limit endoscopic options, necessitating surgical removal. We present a case of massive encrustation of a retained ureteral stent treated with robotic-assisted laparoscopic (RAL) ureterolithotomy. METHODS: We reviewed the medical records of a patient with massive encrustation of a retained ureteral stent placed one year prior in Colombia who was treated with RAL ureterolithotomy at our institution. Footage captured on the da Vinci Xi System was edited in Adobe Premiere to provide a video representation of our technique. A brief literature review was performed in MEDLINE, Emboss, and Preprints using the search term "robotic ureterolithotomy," which resulted in 88 studies. These were reviewed by two investigators for content and applicability, resulting in five studies included for review. RESULTS: Case duration was 194 minutes with an estimated blood loss (EBL) of approximately 15 ml. There were no complications and the patient was discharged on post-op day three with a right ureteral stent and percutaneous nephrostomy tube. Her stent was removed at a subsequent follow-up visit, as was her nephrostomy tube following a successful clamp trial. Due to difficult social circumstances, she is pending follow-up for renal lasix scan.Review of the literature showed 100% stone free rates in adults treated with RAL ureterolithotomy. Our case duration and EBL were similar to published reports, although the stone was significantly larger, at approximately 13 cm. CONCLUSIONS: RAL ureterolithotomy is safe and effective in the treatment of massively encrusted ureteral stents. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e83 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lily Kong More articles by this author Nathaniel Coddington More articles by this author Gary Shahinyan More articles by this author Brian Flynn More articles by this author Expand All Advertisement PDF downloadLoading ...

A comparison between asymptomatic and symptomatic ureteral stones

To investigate the characteristics and impact of asymptomatic (silent) ureteral stones on renal function and compare them with those of symptomatic stones. We retrospectively reviewed the medical records of 677 patients who underwent ureteroscopic lithotripsy or laparoscopic ureterolithotomy for ureteral stones between 2016 and 2020. Patients were divided into two groups according to the presence of recognizable symptoms. We investigated the characteristics and impact of silent stones on post-treatment renal function recovery and compared them with those of symptomatic stones. Among the 677 patients, 43 (6.4%) had asymptomatic ureteral stones, and 634 (93.6%) had symptomatic ureteral stones. Compared to symptomatic stones, asymptomatic stones were larger (11.4 mm vs. 9.6 mm, p = 0.003), more commonly present in the upper ureter (62.7% vs. 48.0%, p = 0.04), and more commonly associated with high-grade hydronephrosis (32.8% vs. 12.3%, p < 0.001); however, no difference in metabolite composition was observed between the two group of stone. In the asymptomatic stone group, the mean preoperative estimated glomerular filtration rate (eGFR) was 77.37 ± 23.54 mL/min/1.73 m2, and the mean postoperative eGFR indicated no significant improvement at 1 day, 7 days, 3 months, and 12 months (76.66 ± 21.45, 77.89 ± 20.87, 77.29 ± 22.22, and 76.71 ± 24.21 mL/min/1.73 m2, respectively; p = 0.567, p = 0.613, p = 0.924, and p = 0.202, respectively). In the symptomatic stone group, the mean preoperative eGFR was 78.17 ± 28.25 mL/min/1.73 m2; the mean postoperative eGFRs at 1 day, 7 days, 3 months, and 12 months were 81.24 ± 26.38, 86.16 ± 25.61, 89.11 ± 25.43, and 89.50 ± 26.01 mL/min/1.73 m2, respectively and demonstrated significant improvement (p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). Silent stones irreversibly impaired renal function, even after proper management. Therefore, active treatment strategies are required for all patients who are hesitant to receive treatment for silent stones because of their asymptomatic status to prevent permanent renal impairment.

Laparoscopic Ureterolithotomy and Single-Use Digital Flexible Ureteroscope For Unilateral Large Ureteral Stone and Small Renal Stone.

BACKGROUND The removal of concurrent ureteral and renal stones within a single procedure has always been a challenge for urological surgeons. The incorporation of single-use digital flexible ureteroscopes into laparoscopic ureterolithotomy procedures has demonstrated effective removal of concurrent stones with a good clearance rate and decreased risk of bleeding and trauma. We report the successful removal of a unilateral upper ureteral stone and a smaller renal stone with this procedure. CASE REPORT A 60-year-old man visited the outpatient clinic with an ultrasonography report that revealed a large proximal ureteral stone with moderate hydronephrosis, accompanied by bilateral renal stones and prostatic hyperplasia. He had been experiencing urinary urgency for a year and was determined to undergo lithotomy. Due to his longstanding history of coronary artery disease and myocardial ischemia, the urologists decided that concurrent stone removal within an operation would be the best treatment. A preoperative computed tomography urogram measured the left ureteral and renal stones to be 2.0×0.8 cm and 0.6 cm, respectively. Both stones were successfully removed by laparoscopic ureterolithotomy using a single-use digital flexible ureteroscope. The patient had an uneventful recovery and remained well 1 month post-operation. CONCLUSIONS The application of single-use digital flexible ureteroscopes for laparoscopic ureterolithotomy has demonstrated safety, efficiency, and cost-effectiveness. The authors believe that it is a safe alternative for the removal of concurrent ureteral and renal stones, especially in patients with multiple comorbidities.

Supine percutaneous nephrolithotomy in impacted proximal ureteral stones larger than 15 millimeters; Comparison of flexible ureterorenoscopy and retroperitoneal laparoscopic ureterolithotomy

Objective: We aimed to compare the efficacy and safety of supine mini-percutaneous nephrolithotomy (SMPCNL), retroperitoneal laparoscopic ureterolithotomy (RPUL), and flexible ureterorenoscopy (FURS) in the treatment of impacted proximal ureteral stones larger than 15 mm in diameter.Material and Methods: Data of the patients who underwent SMPCNL, RPUL, and FURS in our institution for proximal ureteral stones between August 2015 and September 2020 were reviewed. Collected data included age, gender, body mass index (BMI) and hydronephrosis grade, stone density, duration of surgery, hospital stay and recovery period, stone-free and demographic data such as complication rates and duration of surgery.Results: Overall, 162 patients were included. Of these patients, 52 (32.1%) were in Group 1 (SMPCNL group), 53 (32.7%) were in Group 2 (RPUL group), and 57 (35.2%) ) were in Group 3 (FURS group). Mean operative times were 53±8.2 minutes in Group 1, 63.2±6.6 minutes in Group 2, and 73.7±7.5 minutes in Group 3 (p=0.000). The mean hospital stay was significantly shorter in Group 3 compared to the other groups (p=0.000). The stone-free rates at the initial evaluation were 100%, 90.3%, and 87.7% in the RPUL, SMPCNL, and FURS groups. This rate was significantly lower in the FURS group compared to the other groups (p=0.02).Conclusion: SMPCNL and RPUL procedures are as safe as FURS in treating patients with proximal ureteral stones larger than 15 mm.

Analysis and prediction of postoperative recurrence of unilateral upper ureteral calculi in 243 cases (nomogram).

Objective: This study aimed to identify the risk factors for postoperative recurrence of unilateral upper ureteral calculi and develop a predictive nomogram. Patients and Methods: A retrospective analysis was conducted on 243 patients diagnosed with unilateral upper ureteral calculi who were treated at our hospital between January 1, 2016 and December 31, 2018. Patients were divided into two groups: recurrence or non-recurrence cohort. Differences in age, gender, smoking and/or drinking habit, laterality, stone diameter, ureteral stricture, stone incarceration, urinary tract infection, surgical intervention, operation time, body mass index, and metabolic syndrome were analyzed. Discrete risk factors were screened, and a nomogram was developed to predict the probability of stone recurrence. Results: The study found that the recurrence of ureteral calculi was associated with factors including stone diameter, ureteral stricture, stone incarceration, surgical intervention, operation time, metabolic syndrome, body mass index, triglycerides, diabetes, and high blood pressure (p < 0.05). Ureteral stricture, surgical intervention, metabolic syndrome, and triglycerides were found to be discrete risk factors for stone recurrence (p < 0.05). In addition, the study revealed that the stone recurrence rate of metabolic syndrome patients was significantly elevated (p < 0.05), as demonstrated by the survival curve. Lastly, using the nomogram, with an area under the curve value of 0.929, the recurrence rate of ureteral calculi was predicted. Conclusions: The study identified that preoperative ureteral stricture, laparoscopic ureterolithotomy, metabolic syndrome, and triglycerides are closely related to postoperative recurrence of ureteral calculi. The nomogram developed in this study can be used as a predictive tool for the recurrence rate of ureteral calculi.