Retroperitoneal Laparoscopic Ureterolithotomy Group Research Articles

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.

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.

Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm.

Background:The optimal treatment for large impacted proximal ureteral stones remains controversial. The aim of this study was to evaluate the efficacy, safety, and potential complications of mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the treatment of impacted proximal ureteral stones with size greater than 15 mm.Methods:A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019. Data on surgical outcomes and complications were collected and analyzed.Results:Demographic and ureteral stone characteristics found between these two groups were not significantly different. The surgical success rate (139/142, 97.9% vs. 121/126, 96.0%, P = 0.595) and stone-free rate after 1 month (139/142, 97.9% vs. 119/126, 94.4%, P = 0.245) of RPLU group were marginally higher than that of the MPCNL group, but there was no significant difference. There was no significant difference in the drop of hemoglobin between the two groups (0.8 ± 0.6 vs. 0.4 ± 0. 2 g/dL, P = 0.621). The mean operative time (68.2 ± 12.5 vs. 87.2 ± 16.8 min, P = 0.041), post-operative analgesics usage (2/121, 1.7% vs. 13/139, 9.4%, P = 0.017), length of hospital stay after surgery (2.2 ± 0.6 vs. 4.8 ± 0.9 days, P < 0.001), double J stent time (3.2 ± 0.5 vs. 3.9 ± 0.8 days, P = 0.027), time of catheterization (1.1 ± 0.3 vs. 3.5 ± 0.5 days, P < 0.001), and time of drainage tube (2.3 ± 0.3 vs. 4.6 ± 0.6 days, P < 0.001) of MPCNL group were significantly shorter than that of the RPLU group. The complication rate was similar between the two groups (20/121, 16.5% vs. 31/139, 22.3%, P = 0.242).Conclusions:MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm, while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.

Comparative study of ureteroscopic holmium laser lithotripsy, percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for the treatment of complex upper ureteral calculi

Objective To compare the clinical effect and safety of ureteroscopic holmium laser lithotripsy (USL), percutaneous nephrolithotomy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU) for the treatment of complex upper ureteral calculi. Methods A total of 195 patients with complex upper ureteral calculi treated in our hospital from January 2014 to January 2017 were selected as research subjects. All of the patients were randomly divided into three groups with 65 patients in each group. Patients in the three groups were treated with USL, PCNL and RLU, respectively. The operation time, intra-operative blood loss, hospitalization time, operation success rate, postoperative complications and stone clearance rate of the three groups were compared. Results The operation time was significantly longer in RLU group than USL and PCNL groups (P 0.05). The hospitalization time was statistically longer in PCNL group than USL and RLU groups (P 0.05). The successful rate of the operations was 100.0%, 100.0% and 72.3%(47/65) in PCNL, RLU and USL groups, and the stone clearance was 95.4%(62/65), 100.0% and 83.0%(39/47), respectively. The successful rate and the stone clearance rate of PCNL and RLU groups were better than USL group (P 0.05). The incident of postoperative complications rate was 20.0%(13/65), 1.5%(1/65) and 10.6%(5/47) in PCNL, RLU and USL groups, with that of PCNL group the highest, while that of RLU group the lowest (P<0.05). Conclusions PCNL has advantages of short operation time, high stone clearance, but the intra-operative bleeding volume and postoperative complications are high. USL has less risk, but with low stone clearance. RLU is a safe and effective procedure with short operation time, less blood loss, fewer complications and high stone clearance rate. RLU is an ideal approach for the treatment of complex upper ureteral calculi. Key words: Ureteral Calculi; Holmium; Lasers, Solid-State; Nephrostomy, Percutaneous; Laparoscopy; Ureteroscopy

Ureteral stricture formation after removal of proximal ureteral stone: retroperitoneal laparoscopic ureterolithotomy versus ureteroscopy with holmium: YAG laser lithotripsy.

ObjectiveTo compare the risk of postoperative ureteral stricture formation following retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL) in patients with proximal ureteral stones.Materials and MethodsWe retrospectively reviewed the medical records of patients who underwent RPLU or URSL for proximal ureteral stones between April 2011 and May 2015. Patients were allocated into URSL group or RPLU group and the outcomes were compared.ResultsA total of 201 patients who underwent 209 procedures including 159 URSL and 50 RPLU with a median follow-up of 30 months were included. No significant difference was observed among the two groups in most baseline parameters, while the stone size was significantly larger in the RPLU group (11.37 ± 2.97 vs 14.04 ± 4.38 mm, p = 0.000). Patients in RPLU group had markedly longer operative time (p = 0.000) and longer postoperative hospital stay (p = 0.000). The initial and one-month stone-free rates were significantly higher in the RPLU group (78.6% vs 100%, p = 0.000 and 82.4% vs 100%, p = 0.001, respectively). Patients in the RPLU had a higher complication rate (18.0% vs 9.4%, p = 0.098) and lower ureteral stricture rate (2.5% vs 2.0%, p = 1.000), while the difference was not significant. Further logistic regression model identified RPLU and female sex as independent risk factors for postoperative complication (Odds Ratio[OR] = 3.57, p = 0.035 and OR = 3.57, p = 0.025, respectively); however, URSL was not an independent risk factor for the formation of postoperative ureteral stricture after adjusting confounding variables (OR = 0.90, p = 0.935).ConclusionRPLU and URSL have similar postoperative ureteral stricture formation risks. RPLU can provide significantly higher stone clearance rate, but relates with more postoperative complications.

Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial

BackgroundThere are three minimally invasive methods for the management of large upper impacted ureteral stones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and retroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to evaluate which one is the best choice for large upper impacted ureteral stones.MethodsBetween January 2012 and December 2015, at the Department of Urology, Huai’an First People’s Hospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included. The patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was success of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and postoperative parameters and complications.ResultsFifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The stone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group the stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083 vs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was shorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the longest with MPCNL (all P < 0.05).ConclusionsMPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be considered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery.Trial registrationThis study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR-INR-17011507; Registration date: 2017–5-22).

Comparison of curative efficacy of two kinds of treatments for upper ureteral calculi under the same learning curve

Objectives To compare the efficacy of percutaneous nephroscope lithotripsy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (RLUL) in the treatment for ureter-stuck stones by the same doctor under the same learning curve. Methods 92 patients with obstructive upper ureteral calculus from August 2008 to August 2014 in our hospital were selected, according to the digital method who were randomly divided into PCNL group and RLUL group, each of 46 cases. The peration time, peroperative bleeding, postoperative fever rate (>38. 5℃), postoperative bleeding, rate of residual stones in the ureter, hospitalization time were compared. Results All the operations were completed. Peroperative bleeding of PCNL group and RLUL group was(58.02±27.16)mL, (21.74±10.18)mL, respectively. Hospitalization time of PCNL group and RLUL group was(9.07±0.77)d, (7.59±0.88)d, respectively. There were statistically significant differences in rate of residual stones between the PCNL group and RLULgroup (P <0.05). The patients were followed up for 1 to 36 months (mean, 10 months), no recurrence was found in both groups. Conclusions Both PCNL and RLUL are safe, effective, and feasible for incarcerated upper ureteral calculi. Key words: Ureteral Calculi; Nephrostomy, Percutaneous; Laparoscopes

Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections

The aim of this study is to compare the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopic holmium laser lithotripsy (UHLL) as two minimally invasive procedures in managing obstructive upper ureteral calculi with concurrent urinary tract infections (UTI). The retrospective study included 189 patients who underwent unilateral obstructive upper ureteral stones with concurrent UTI from January 2007 to November 2014 at our institution. Patients received RPLU (81 cases) or UHLL (108 cases). All patients received preoperative anti-infection treatment (indwelling ureteral stent and/or preoperative antibiotics). Collected data, including sex, age, stone size, success rate, operation duration, post-operation hospitalization time, and post-operation complications, were compared. All patients were followed up for more than 6months after surgeries, and no ureterostenosis occurred. The study included 189 patients, 41 (21.7%) females and 148 (78.3%) males with a medium age of 52years (range 22-81years). All surgeries were successfully performed without conversion to open surgery. Stone size in the RPLU group was larger than that of the UHLL group (16.1 ± 1.4 vs. 10.4 ± 1.6mm, P = 0.012). Operative duration (P = 0.009) and hospitalization time (P < 0.001) in the UHLL group were significantly shorter than those in the RPLU group, whereas stone clearance rate was significantly higher in the RPLU group (100 vs. 88.9%, P = 0.002). Of note, postoperative fever was more common in patients treated with UHLL (15 cases) versus RPLU (4 cases) (13.9 vs. 4.9%, P = 0.043). Moreover, in the UHLL group, three patients without a preoperative indwelling ureteral stent were complicated with sepsis, which was not seen in RPLU group. In our study, the safety and stone clearance rate of RPLU are better than those of UHLL in the treatment of unilateral upper ureteric calculi with concurrent UTI. Preoperative antibiotics and indwelling ureteral stent may reduce the risk of postoperative infections.

Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm.

To compare the results of ureteroscopic lithotripsy (URSL) with retroperitoneal laparoscopic ureterolithotomy (RPLU) as two minimally invasive techniques in the management of proximal ureteral stones larger than 12 mm. From January 2009 to October 2013, patients with impacted unilateral upper ureteral stones larger than 12 mm were enrolled including 182 males and 93 females with a medium age of 40 years (22-72 years). Patients were randomized to receive URSL (139 cases) with semirigid ureteroscope or RPLU (136 cases). Stone size was similar in RPLU and URSL groups (13.8 ± 1.9 vs 13.6 ± 1.4 mm, P = 0.312). Operating time and hospitalizing days in URSL group were significantly shorter than those in RPLU group (P < 0.001), whereas stone clearance rate was significantly higher in RPLU group (97.1 vs 89.9 %, P = 0.017). Ureteral strictures happened higher in URSL group (5 patients, 3.6 %) than RPLU group (2 patients, 1.5 %) with no statistical significance, while the strictures requiring surgical intervention were significantly higher in URSL group (4 cases) (2.9 vs 0 %, P = 0.046). RPLU could provide better stone clearance rate than semirigid URSL for upper ureteral impacted stones larger than 12 mm. It may also reduce the chance of surgical intervention for postoperative ureteral stricture.

Comparison of clinical efficacy of retroperitoneal laparoscopic ureterolithotomy, ureteroscopy or microchannel percutaneous nephrolithotomy in the treatment of impacted upper ureteral calculi

Objective To evaluate the effect of retroperitoneal laparoscopic ureterolithotomy(RLUL), ureteroscopy(URS), microchannel percutaneous nephrolithotomy(mPCNL)in the treatment of impacted upper ureteral calculi. Methods Clinical data of 105 cases with impacted upper ureteral calculi were retrospectively analyzed.The average residence time of stone in the same position was 8.6(2- 49) months and the average stone surface area were 171(71- 361)mm2 in 41 cases received RLUL treatment. The average residence time of stone in the same position was 9.5(2- 47) months and the average stone surface area were 159(71- 342)mm2 in 29 cases received URS treatment.The average residence time of stone in the same position was 8.9(2- 51) months and the average stone surface area were 165(71- 353)mm2 in 35 cases received mPCNL treatment. Results In the RLUL group,surgery was successful in all patients and the stone- free rate was 100%; In the URS group, the surgery success rate was 93.1% and the stone- free rate 1 month later was 92.6%;In the m PCNL group,the surgery success rate was 97.1% and the stone- free rate 1 month later was 97.0%. The operation time in the URS group(mean 65 min,ranged 45- 95 min) was longer than that in the RLUL(mean 46 min, ranged 25- 70 min) and m PCNL(mean 51 min, ranged 39- 80 min)groups(P 0.05). The surgery success rate, stone- free rate and the serious complications of the three groups had no significant differences(P> 0.05). Conclusion The operation time of URSis shorter, but postoperative recovery is faster than that of RLUL and mPCNL groups. Although the incidence of serious complications has no statistically significant differences among the three treatments, but URS and mPCNL surgery have the potential risk of serious complications. RLUL does not increase the difficulty of operation, has less serious complications, and is a remedy for failure in URS and mPCNL operation. Key words: Ureteral calculi; Laparoscopy; Ureteroscopy; Percutaneous nephrolithotomy

Comparison of therapeutic effects of transureteroscope holmium laser lithotripsy and retroperitoneal laparo-scopic ureterolithotomy for unilateral upper ureteral calculi

Objective To compare the therapeutic effects of transureteroscope holmium laser lithotripsy （ URL） and retroperitoneal laparoscopic ureterolithotomy （ RLU） for unilateral upper ureteral calculi and evaluate the selection of indications and clinical value of URL and RLU .Methods 37 patients were enrolled into the study . 14 patients received URL ,23 patients received RUL .Double-J stent was routinely indwelled in both groups .The oper-ation time,hospitalization time,clearance rate of the stone and incidence of postoperative complications .Results The stone clearance rate after postoperation of RLU group was 100%, which was significantly higher than that of URL group 64.4%（χ2 =4.15,P〈0.05）.The mean operation time in RLU group was（132.0 ±7.8）min,which was sig-nificantly longer than URL group（46.5 ±7.2）min（t=6.23,P〈0.05）.The mean intraoperative blood loss of RLU group was（38.0 ±4.6）mL,which was significantly higher than URL group （10.0 ±3.2）mL（t=5.20,P〈0.05）. The postoperative complication rate of RLU group was 8.7%,which was significantly lower than URL group 21.5%（χ2 =4.06,P〈0.05）.There was no significant difference in hospitalization time and stone clearance rate between the two groups（P〉0.05）.Two cases converted to operation in URL group ,while only 1 case converted to operation in RLU group.Conclusion Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy .Laparoscopic ureterolithotomy is a safe and effective therapeutic method for unilateral upper ureteral stones . Key words: Ureteral stone; Laparoscopy; Ureteroscopy

A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.