Laparoscopic Ureterolithotomy Research Articles

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

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.

First Robot-Assisted Laparoscopic Ureterolithotomy with HUGO Robot-Assisted Surgery System

First Robot-Assisted Laparoscopic Ureterolithotomy with HUGO Robot-Assisted Surgery System

Subcapsular renal haematoma after ureteroscopic lithotripsy: a single-centre, retrospective study in China

ObjectivesTo investigate the incidence, predisposing factors, diagnosis and management of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL).DesignRetrospective observational study.SettingShandong Provincial Hospital, a 4500-bed tertiary hospital in China.ParticipantsThe data from...

Double‐J stent placement during laparoscopic ureterolithotomy: the “seagull” technique

To present a new technique of double-j stent (DJ) placement during laparoscopic transperitoneal ureterolithotomy (LUL). Following the extraction of the stone, a 6 French DJ open-end stent is prepared: two straight-tip hydrophilic guidewires are inserted into the appropriate lateral holes of the stent, as identified by the preoperative evaluation of the CT scan. Approximately 5 centimeters of each wire protrude from the proximal and distal ends of the stent to straighten its terminal curl, thus resembling the wings of a flying seagull. The remaining proximal portions of both guide wires are left within each guidewire dispenser. The two ends of the stent are grasped together in a U-fashion and inserted into the abdomen through a 10mm port. Once in the abdomen, the longer segment of the stent is inserted and pushed into the ureterotomy until it reaches the target site. The guide wire is then removed. The same procedure is repeated for the other end of the stent. A brief literature review on the currents techniques of laparoscopic DJ placement is also presented. Analyzing the outcomes of 21 LUL, the "seagull" technique is time-saving and safe. No perioperative complications were encountered. There is no risk of enlarging or tearing the ureterotomy and no need for patient replacement, extra cystoscopic or ureteroscopic procedures as well as of using modified guidewires and closed-tip stents. We described our step-by-step technique for DJ placement during LUL.

Comparison of laparoscopic ureterolithotomy and retrograde lithotripsy in the treatment of proximal ureteral stones

The current approach in the surgical treatment of ureteral calculi involves the use of endourological procedures such as retrograde ureteroscopy with lithotripsy or percutaneous antegrade lithotripsy in the proximal ureter. Ureterolithotomy as a treatment method is of an auxiliary nature and is used when endourological intervention is impossible or in case of intraoperative collisions during access conversion. However, there are several comparative studies on lithotripsy and lithotomy.The aim. Comparative analysis of the outcomes of laparoscopic lithotomy and retrograde lithotripsy in the surgical treatment of proximal ureteral calculi, as well as the search for predictors of prolonged disability.Materials and methods. A prospective randomized multicenter study included 53 patients with an established diagnosis of ureterolithiasis who were treated in the period 2018–2021 in urological hospitals in Irkutsk. All patients were divided into two comparison groups: Lithotomy group (group 1; n = 30) and Lithotripsy group (group 2; n = 23).Results. When analyzing the results of the study, it was found that the level of complications of class II–III according to Clavien – Dindo was statistically comparable in both groups (p &gt; 0.05). However, in absolute and relative terms, the prevalence of this indicator was noted during retrograde ureterolithotripsy. According to hard endpoints (reoperation, presence of residual stones or migration during the operation), 29 (96.6 %) patients of group 1 and 17 (73.4 %) patients of group 2 (p = 0.514) were successfully operated on.Conclusion. Laparoscopic ureterolithotomy may be offered to patients with large proximal ureteral stones as an alternative treatment option with better residual stone freedom but generally similar overall outcomes and complication rates.

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.

Laparoscopic retroperitoneal ureterolithotomy for large, impacted calculi in upper and mid ureter

Background: Urolithiasis is a common recurrent condition in which the stones are formed within the urinary tract and lead to symptoms when they cause obstruction in the renalpelvicalyceal system, ureters, bladder and the urethra.Most cases of urolithiasis can be managed with non-invasive strategies, however, urolithiasis associated with infections, obstructions, and renal failure may require interventional measures such as ureteroscopy (URS), Percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL). Although open surgeries arealmost obsolete in urological centers, laparoscopic ureterolithotomy (LU) is required in the special group of patientsand also as a salvage procedure for failed URS &amp;/or SWL. It is also widely used as a primary procedure for large stones at centers that do not have access to URS and SWL. The aim of the present study was to prospectively evaluate the efficacy, safety, and complication rates of retroperitoneal laparoscopic ureterolithotomy in the treatment of large, impacted proximal, and mid ureteric calculi. Methodology: Thirty patients who underwent laparoscopic retroperitoneal ureterolithotomy between February 2010 to May 2012 were enrolled in the study.Proximal and mid ureteric stones were removed retroperitoneally.

Comparison of Transperitoneal and Retroperitoneal Laparoscopic Ureterolithotomy: A Meta-Analysis

Purpose: The aim of this study was to evaluate the efficacy and safety of transperitoneal and retroperitoneal laparoscopic ureterolithotomy (TLU and RLU). Materials and Methods: We undertook a literature search PubMed, Embase, and the Cochrane Library. Search date will range from inception to January 1, 2020. The final article results will be analyzed using StataSE 12 software. This meta-analysis was reported according to PRISMA guidelines, and a protocol was registered in PROSPERO (CRD42020160906). Results: Eleven articles eventually met the requirements, involving a total of 609 patients. The final result shows the operative time (Std. Mean Difference [SMD] = 0.58; 95% CI 0.36–0.80; p < 0.01), hospital stay (SMD = 0.26; 95% CI 0.02–0.49; p = 0.031), and the complication of paralytic ileus (risk difference = 0.11; 95% CI 0.05–0.17; p < 0.01) are significant difference between TLU and RLU, and TLU are higher or longer. Conclusions: Our meta-analysis suggests that if there are no other constraints, it is better to choose RLU. And more clinical trial data are needed to confirm this conclusion.

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&lt;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.