Retroperitoneoscopic Ureterolithotomy Research Articles

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

Features of using ureteral stents after retroperitoneoscopic ureterolithotomy in the treatment of ureteral stones

We analyzed the results of treatment of 53 patients who underwent laparoscopic ureterolithotomy for ureteral stones. In 18 (34 %) cases, the stent was not used after the surgery (group 1), and in 35 (66.0 %) patients, the stent (group 2) was placed. Drainage of the ureter by stent placement is absolutely justified procedure in the presence of significant changes in the ureteral wall. In our opinion, the following changes are important: swelling of all layers, the presence of ulcers of the mucous membrane, perifocal inflammation in the tissues surrounding the ureter, with the formation of an inflammatory cortex. On the other hand, stenting of the ureter after retroperitoneoscopic ureterolithotomy is not a routine procedure, and in the absence of the above-mentioned changes, it can be refused without any complications.

Prevention and management of the calculus drift in retroperitoneoscopic ureterolithotomy for complex upper ureteral calculus

Objective To investigate the prevention and management of the calculus drift in retroperitoneoscopic ureterolithotomy for complex upper ureteral calculus. Methods The clinical data of 13 cases of the calculus drift in retroperitoneoscopic ureterolithotomy for complex upper ureteral calculus were retrospectively analyzed. Results Stones drifted into the renal pelvis in 10 cases, while stones drifted into the upper calyx in 2 cases and stone drifted into the middle calyx in 1 case.Stones were removed by stone basket successfully in 10 cases, while stones were removed by flexible ureteroscopy in 3 cases. Conclusions Stone basket, when necessary, flexible ureteroscopy can be used to deal with the calculus drift in retroperitoneoscopic ureterolithotomy for complex upper ureteral calculus effectively. Key words: Ureteral Calculi; Laparoscopes

Five-Year Single Center Experience for Retroperitoneoscopic Ureterolithotomy.

Narrow working space is a major problem to overcome during retroperitoneoscopic ureterolithotomy. We evaluated initial 5 years experience of retroperitoneoscopic ureterolithotomy for large impacted upper ureteral calculi. Between January 2011 and December 2015, a total of 37 consecutive patients were evaluated. A 12-mm camera port at middle of midaxillary line and two 5-mm working ports in posterior axillary line were created. The stone was extracted through the site of camera trocar. A Double-J catheter (DJC) was placed antegradely by four steps (elevating of the proximal shaft, introducing the end of curl, advancing, and twisting) during retroperitoneoscopic ureterolithotomy. A knotless unidirectional barbed suture was applied to the incision site of the ureter in all cases. All patients were followed up at 2 weeks after discharge to remove a DJC and at 6 weeks after discharge to evaluate urinary drainage with intravenous urography. The mean ± standard deviation for age (years), body mass index (kg/m2), stone size (mm), and postoperative hospital days were 57.9 ± 13.3, 24.6 ± 4.5, 15.5 ± 4.0, and 3.2 ± 1.2, respectively. Stones were successively removed without critical complications such as ureteral stricture in all cases. Total operation time, the time for placing a DJC, and ureteral suturing time at initial three trials were more than 150 minutes, more than 30 minutes, and about 15 minutes, respectively; however, they were about 60 minutes, less than 10 minutes, and about 5 minutes, respectively, in 25 case experiences. Retroperitoneoscopic ureterolithotomy is a safe and excellent alternative for large impacted upper ureter stone. When performing retroperitoneoscopic ureterolithotomy in the narrow space, our step by step methods, including working port creation, DJC placement, and suturing, will be helpful for surgeons to learn the procedure easily.

Comparative analysis of upper ureteral stones treated with retroperitoneoscopic ureterolithotomy and percutaneous nephrolithotomy

To explore an appropriate treatment for patients with upper ureteral stone (>15 mm in size) by comparing the therapeutic outcomes for those undergoing retroperitoneoscopic ureterolithotomy (RPUL) and percutaneous nephrolithotomy (PCNL). A total of 62 patients with large upper ureteral stone were divided randomly into 2 groups. RPUL was performed in group A (n=30) and PCNL in group B (n=32). No significant inter-group difference existed in age, gender, stone location and size, operative duration or surgical success rate (P>0.05). Blood loss volume, rate of postoperative analgesic usage, time of hospital stay and incidence of postoperative complications in group A were significantly lower than those of group B (P<0.05). Thus RPUL offers more advantages and better efficacies. Key words: Laparoscopy; Nephrostomy, percutaneous; Ureteral calculi

Retroperitoneoscopic versus open mini-incision ureterolithotomy for upper- and mid-ureteric stones: a prospective randomized study

To compare the retroperitoneoscopic ureterolithotomy (RPLU) versus open mini-incision ureterolithotomy (MIOU) for large and impacted proximal or mid-ureteric stones in prospective randomized manner and to assess the outcome results. In a prospective randomized study between January 2009 and December 2012, 35 RPLU and 35 MIOU were included in the study. The indications for ureterolithotomy were as primary treatment of large and impacted stones more than 1.5 cm in the proximal and mid-ureter and as salvage treatment of failed ureteroscopy (URS)/extracorporeal shock wave lithotripsy (SWL). The two groups were compared for visual pain score on the first and second postoperative day, analgesic requirement, stone removal in one attempt, operative time, blood loss, postoperative complications, hospital stays and the period of convalescence. The difference in the visual pain score and the tramadol requirement was significantly higher in MIOU group. The hospital stay (RPLU 2.86 ± 0.43, MIOU 5.71 ± 0.67, P ≤ 0.001) and period of convalescence (RPLU 12.29 ± 4.06, MIOU 24.11 ± 5.55, P ≤ 0.001) were also significantly higher in MIOU group. The complications were 11.4 % (P ≤ 0.02) in RPLU versus 17.4 % in MIOU group. However, the stone removal in one attempt was similar in both groups. In condition of failed URS/SWL, unavailability of the full endoscopic armamentarium and limitation of costs, RPLU and MIOU both are safe and effective treatment options for large impacted upper- and mid-ureteric stones and RPLU has better tolerability, lesser hospital time and equal stone clearance rate.

Retroperitoneal laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease

Objective. The aim of this article was to present this group's clinical experience with retroperitoneal laparoendoscopic single-site (LESS) ureterolithotomy for the management of upper ureteral stones in selected patients. Material and methods. From May 2011 to November 2012, retroperitoneal LESS ureterolithotomy was performed in 22 patients at Xiangya Hospital. During the operation, a transverse skin incision was made approximately 2.5 cm in length along the lower margin of the 12th rib at the midaxillary line, and a single port was inserted. Standard steps of a multisite retroperitoneoscopic ureterolithotomy with a combination of conventional straight instruments and bent instruments were performed. Results. All cases were completed successfully without conversion to standard laparoscopy or open surgery. No additional ports or expensive flexible instruments were required. Overall, mean operative time was 98.5 min (range 76--174 min) and mean estimated blood loss was 33.4 ml (range 18--53 ml). Mean hospital stay after surgery was 3.7 days (range 3--5 days). One patient had fever postoperatively due to an Escherichia coli urinary tract infection, which resolved with appropriate antibiotic therapy. There were no major complications. The mean follow-up period was 10.5 months (range 3--21 months). All patients were asymptomatic and did not exhibit signs or symptoms of obstruction or stricture. Conclusions. Retroperitoneal LESS ureterolithotomy is a feasible, safe and effective surgical method for the treatment of upper ureteral stones in select patients. Prospective studies based on more patients are needed to evaluate further its advantages over conventional laparoscopic ureterolithotomy.

Comparative study of therapeutic effects between retroperitoneoscopic ureterolithotomy and ureteroscopic lithotripsy for upper ureteral calculi

Objective To compare the effect of retroperitoneoscopic ureterolithotomy (RPUL) and ureteroscopic lithotripsy (URL) for upper ureteral calculi.Methods One hundred and twenty cases treated by RPUL and 108 cases by URL from January 2002 to October 2012 were reviewed.In RPUL and URL group,the diameter of stone was (1.56 ± 0.52) cm vs (1.44 ± 0.46) cm,ipsilateral hydronephrosis was (2.85 ± 0.86) cm vs (2.76 ± 0.82) cm,body mass index was (23.65 ± 2.80) kg/m2 vs (22.54 ± 2.68) kg/m2.There were no signficant differences.Data on the operation time,the hospital stay after operation,the operation,successsful rate,complication incidence and stone-free rate were compared between the 2 groups.Results Comparisons between RPUL group and URL group included the following:the operation time was (75.5 ± 25.8) min vs (62.5 ± 15.3) min,the hospital stay after operation was (6.2 ± 1.2) d vs (4.0 ± 0.8) d.There were significant differences.The operation successful rate was 95.0％ (114/120) in RPUL group and 85.2％ (92/108) in URL group.The complications incidence rate was 3.5％ (4/114) in RPUL group and 17.4％ (16/92) in URL group.The stone-free rate was 100.0％ (114/114) in RPUL group and 89.1％ (82/92) in URL group.The differences were significant (P ＜ 0.05).Conclusions RPUL and URL had the advantages of less trauma and blood loss and rapid recovery.RPUL had fewer complication and higher success rate than URL,and could be a minimally invasive option for the treatment of ureteral calculi. Key words: Ureteral calculi; Laparoscopy; Ureteroscopy; Lithotripsy; Treatment outcome

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Large and impacted lower ureteral calculi are a difficult proposition when ureteroscopy is considered, because of the longer operating periods and possible complications. 1 Tuğcu V. Taşc A.I. Özbek E. et al. Does stone dimension affect the effectiveness of ureteroscopic lithotripsy in distal ureteral stones?. Int Urol Nephrol. 2008; 40: 269-275 Crossref PubMed Scopus (16) Google Scholar , 2 Mandal S. Goel A. Singh M.K. et al. Clavien classification of semirigid ureteroscopy complications: a prospective study. Urology. 2012; 80: 995-1001 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar Laparoscopic and retroperitoneoscopic ureterolithotomy have featured as management options for experienced laparoscopists in these situations. 3 Hruza M. Schulze M. Teber D. et al. Laparoscopic techniques for removal of renal and ureteral calculi. J Endourol. 2009; 23: 1713-1718 Crossref PubMed Scopus (43) Google Scholar For impacted, large, lower ureteral stones, for which the depth of the pelvis poses a significant challenge, the benefits of robotic surgery have an important bearing on the clearance rates and operative time. It is true that by 2013 laparoscopic suturing had become a standard procedure among laparoscopic urologists; however, laparoscopic suturing is still a challenge for most urologists. Editorial CommentUrologyVol. 82Issue 1PreviewMost ureteral calculi can be managed by extracorporeal shock wave lithotripsy or semirigid ureteroscopy.1 The trend has been to prefer ureteroscopy, because most patients will present with acute colic requiring insertion of a double-J stent. Full-Text PDF

Choice of surgical access for retroperitoneoscopic ureterolithotomy according to the results of 3D reconstruction of operational zone agreed with the patient: initial experience.

IntroductionFor the procedure retroperitoneoscopic ureterolithotomy, the problems of access choice and thus visualization with utilizing minimally invasive surgical access (either with gasless single port method or gas insufflation) are solved. The decisions are based on the method of presurgery planning, grounded on matching the patient with a 3D model of the zone of surgical interest reconstructed according to the results of tomographic examination.Material and methodsWe used a hardware–software complex (HSC) for virtual modeling of the surgery zone and choosing the optimum points for minimally invasive surgical access. The HSC was recruited to choose optimum surgical access, realize presurgery planning, and estimation of the safety of the way of access chosen. The original method of matching the system of coordinates of a virtual model with the patient was offered.Results12 patients with the calculus in the upper part of ureter averaging 11.5 (9–14) mm in size underwent gasless retroperitoneoscopic ureterolithotomy with use of the HSC. Mean age of the patients was 36.4 (25–49) years old. The surgeries lasted an average of 35.5 (25–40) minutes. Blood loss was averaged at 55.0 (30–90) ml. Healing by first intention was registered with all the patients. The mean hospitalization time was 6.0 (4–7) days. There were neither any complications nor difficulties, nor conversions from incorrectly chosen surgical access.ConclusionsThe choice of the optimum surgical access according to the results of a virtual 3D model of the operation zone, matching the system of coordinates of the model with patient concurrence, and presurgery planning, was effective in cases of gasless single port and with gas insufflation retroperitoneoscopic ureterolithotomy.

Transperitoneal Versus Retroperitoneal Laparoscopic Ureterolithotomy: A Prospective Randomized Comparison Study

We compared laparoscopic transperitoneal and retroperitoneal ureterolithotomy approaches, and determined whether one technique is superior to the other. In this prospective randomized study from January 2009 to May 2012, 48 patients with proximal or mid ureteral stones underwent transperitoneal laparoscopic ureterolithotomy or retroperitoneal laparoscopic ureterolithotomy. The randomization occurred on a 1:1 basis. Groups 1 and 2 consisted of patients who underwent transperitoneal laparoscopic ureterolithotomy and retroperitoneal laparoscopic ureterolithotomy, respectively. Demographic and clinical characteristics as well as postoperative data were collected and analyzed. Statistical analysis was performed with SPSS® version 15.0 using the Fisher exact and Mann-Whitney U tests with p <0.05 considered statistically significant. The difference in visual pain analog score and mean tramadol requirement on days 1 and 2 between the 2 groups was statistically significant, and was higher in group 1 (p <0.05). Postoperative hospital stay and paralytic ileus rates were significantly higher in group 1 (p <0.05). The differences in total operative time and intracorporeal suturing time between the 2 groups were not statistically significant. However, successful stone removal was equal in the 2 groups. For proximal or mid ureteral large and impacted stones, transperitoneal laparoscopic ureterolithotomy is significantly associated with pain, greater tramadol requirement, ileus and longer hospital stay than retroperitoneal laparoscopic ureterolithotomy. However, successful stone removal remains the same in both groups.

O emprego do cateter duplo J diminui as complicações na ureterolitotomia retroperitoneoscópica

To evaluate the retroperitoneoscopic ureterolithotomy in the treatment of ureteral calculi and the need for double-J catheter to reduce the procedure-related complications. We conducted a retrospective study with 47 patients submitted to retroperitoneoscopic ureterolithotomy, of which 31 were selected and divided into two groups: Group 1, whose patients did not have double-J catheter placement, and Group 2, who underwent perioperative double-J catheter implantation. Data collected comprised pre-and post-operative excretory urography, operative time, postoperative analgesia, length of hospital stay and catheter removal. The groups were similar as for age and gender, degree of dilation of the urinary tract, position and average size of the calculi (Group 1 = 15.5 ± 6.6 mm, Group 2 = 16.3 ± 6.1 mm). Operative time was also not significantly different (Group 1 = 130 ± 40.3 min, Group 2 = 136.3 ± 49.3 min). Group 1 had six patients (37.5%) with early (four cases of urinary fistula) and late complications (one case of stenosis of the ureter, one case of functional exclusion of the operated kidney), while Group 2 had no complications. This difference was statistically significant (p = 0.011). The use of double-J catheter was associated with significantly fewer complications in retroperitoneoscopic ureterolithotomy. Surgical time, postoperative analgesia and length of stay were similar between groups with and without catheter.

Retroperitoneoscopic ureterolithotomy for upper ureteral calculus: 69 cases

To review the technical details of retroperitoneoscopic ureterolithotomy and evaluate the clinical effect. Between June 2004 and December 2008, 69 patients (55 males and 14 females) with upper ureteral calculus received retroperitoneal laparoseopic ureterolithotomy (40 left sides and 29 right sides). The stone size ranged from 1.5 to 3.1 cm [(2.2±0.6) cm]. All the patients underwent retroperitoneoscopic ureterolithotomy. The operation time was 40-295 (63.1±19.8) min,and the blood loss was 30-150 (57.2±23.0) mL.The hospital stay was 5-8 (6.7±1.3) d. During the followup, there was neither ureteral stricture nor recurrent calculus. Retroperitoneoscopic ureterolithotomy is safe, effective and minimally invasive, which may replace the conventional open surgery.

Comparative analysis of upper ureteral stones (&gt;15 mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy

To investigate an appropriate treatment for patients with upper ureteral stones, > 15 mm in size, by comparing the therapeutic outcomes for those undergoing retroperitoneoscopic ureterolithotomy (RPUL) and rigid ureteroscopic pneumatic lithotripsy (URSPL) retrospectively. During the study period, 81 patients with a large upper ureteral stone (> 15 mm) were divided into two groups. RPUL was performed with retroperitoneal approach, and the stone was removed in group A. URSPL was conducted using a rigid ureteroscope, and pneumatic probe was used for lithotripsy in group B. The patient characteristics, success rate, stone-free rate, operation time, and complications were analyzed prospectively in the two groups. The success rates of operation were 94.5% (34/36) in group A and 88.8% (40/45) in group B, but there were no significant differences between two groups (P > 0.05). After 4 weeks of follow-up, the stone-free rate after RPUL (100%, 34/34) and URSPL (77.5%, 31/40) groups were statistically different (P = 0.006). Furthermore, simultaneous ureterolithotomy and ureteroplasty by retroperitoneal laparoscopic surgery were performed on four patients combined with ureteral stricture. However, the mean operation time and hospital staying time after surgery in group A were longer than that in group B, and the differences were statistically significant (P < 0.05). The complication rate after RPUL (17.6%, 6/34) was lower than that after URSPL (20%, 8/40), but the differences were not statistically significant (P > 0.05). RPUL is a safe and effective treatment technique for large, impacted, upper ureteral stones >15 mm in size when first-line treatments have failed or are unlikely to be effective. It can handle with combined pathologies simultaneously.

Transperitoneal Laparoscopic Ureterolithotomy versus Retroperitoneoscopic Ureterolithotomy

Background and purpose: Most ureterolithiasis that require surgical management are currently managed with minimally invasive procedures like shockwave lithotripsy, ureteroscopy with lithotripsy and percutaneous nephrolithotripsy. In cases where the above procedures will most likely fail or has failed, laparoscopic ureterolithotomy in either transperitoneal laparoscopic ureterolithotomy (TPUL) or retroperitoneoscopic ureterolithotomy (RPU) is a viable option compared to open ureterolithotomy. The goal of this review is to compare the effectiveness and safety of transperitoneal laparoscopic ureterolithotomy and retroperitoneoscopic ureterolithotomy in the treatment of large, chronically impacted ureterolithiasis or as salvage treatment after failed shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy by reviewing patient selection, operative time, blood loss, hospital stay, complications, open conversion rate and success rate. Material and methods: A systematic literature search was performed using Highwire press, Medline, Springer link, Medscape, Google and article bibliographies to identify relevant references. Included studies must have reported outcome data for more than 20 patients with a minimum follow-up of 3 months. Stone size, operating time, blood loss, hospital stay, complications, open conversion rate and success rate were reviewed. Aims and objectives: The aim of this study was to compare the effectiveness and safety of transperitoneal laparoscopic ureterolithotomy (TPUL) and retroperitoneoscopic ureterolithotomy (RPU) in the surgical management of ureterolithiasis. The following parameters were evaluated for both procedures. 1. Operative technique.

Ingenious Laparoscopic Knife

Retroperitoneoscopic ureterolithotomy may be an option in selected group of patients. We present our cost effective, reliable ingenious laparoscopic knife of ureteric incision during retroperitoneoscopic ureterolithotomy. Ingenious laparoscopic knife is made by firmly tying stab knife to 5 mm laparoscopic instrument. This knife is passed through 10-mm renal angle port for making ureteric incision. Ingenious laparoscopic knife has been successfully used in 22 patients with no intraoperative and postoperative complications. Ingenious laparoscopic knife is cost effective, reliable instrument for ureteric incision during retroperitoneoscopic ureterolithotomy.

Laparoscopic ureterolithotomy: Its role and some controversial technical considerations

To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. Between July 1997 and December 2004, retroperitoneoscopic ureterolithotomy was performed as a primary procedure in 30 patients who had either large or impacted stones in the upper ureter. The other indications were stones which could not be fragmented by shock wave lithotripsy or the patients could not afford the cost of shock wave lithotripsy. The mean (range) age of the patients was 44.07 years (17-78) and the mean (range) stone size was 19.03 mm (10-40). The ureter was closed with intracorporeal laparoscopic suture without placing a stent. The stone was removed in all but one case. The mean (range) operative time was 121.38 min (75-270). No intraoperative complications were recorded. The mean (range) postoperative drain removal was 2.86 days (2-10). Postoperative complications included prolonged urinary leakage in one patient. On the sixth month of follow up, all patients were stone free without any evidence of ureteral stricture. Laparoscopic ureterolithotomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted upper ureteric stones. The technical recommendations were retroperitoneal access and suturing the ureterotomy incision. Ureteral stent should be placed in only cases of severe inflammation of the ureter or inappropriate suturing.

Minimally invasive retroperitoneoscopic ureterolithotomy.

We assessed the efficacy of modified technique of retroperitoneal ureterolithotomy for managing ureteral stones. Between December 1999 and March 2002, 31 patients underwent retroperitoneal ureterolithotomy. In most cases only 3 ports (a 10 mm., 2 5 mm. and in a few 2, 3 mm.) were used without any ureteral stent or catheter. The stone was removed from the primary port site, while visualizing retrieval through the 3/5 mm. port using fine laparoscope. Ureterotomy closure was performed by intracorporeal interrupted sutures of 4-zero polyglactin. The 20 males and 11 females had a mean age of 38.5 years. Mean operative time was 67 minutes and mean hospital stay was 2.4 days. The mean analgesic requirement was 42.2 mg. meperidine. Mean followup was 8 months. There were no significant postoperative complications except persistent urine leakage in 2 patients 48 hours after surgery. An internal stent was placed and leakage subsided without any consequences. The modified, minimally invasive technique of retroperitoneal ureterolithotomy is highly effective and efficient without an associated increase in the complication rate.

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

Introduction: Most upper or middle ureteral stones are treated with shock wave lithotripsy or endoscopic techniques. In rare cases the ureteral stones are treated with open surgery after failure of first-line treatments. Retroperitoneoscopy is a minimally invasive alternative to open surgery. Patients and Methods: Between May 1995 and January 2001, twenty-one patients underwent retroperitoneoscopic ureterolithotomy. The stones in upper and middle ureter were large and impacted (5 patients) or not fragmented after shock wave lithotripsy (16 patients). A balloon dissector was placed and infiltrated with 800 ml air in the retroperitoneal space. Three 10-mm trocars were used. The pressure was kept at 15 mm Hg by carbon dioxide insufflation. The stones were extracted from the ureter using a laparoscopic stylet. Results: The stones in 17 patients were successfully removed in a median operating time of 105 (min–max 45–190) min. Urine extravasation in all cases and pnomoscrotum in 2 cases were observed as postoperative complications. The median hospital stay was 6 (min–max 3–22) days with minimal analgesic requirement. Conclusion: Retroperitoneoscopic ureterolithotomy is a useful and effective alternative treatment technique to open surgery when first-line treatments have failed or are unlikely to be effective.

The laparoscopic stylet.

A new instrument, laparoscopic stylet, developed for the laparoscopic extraction of the ureteral and renal pelvis calculi is described. The laparoscopic stylet is made of chromium nickel as a modification of the classical stylet. Until now, this instrument has been used in 11 retroperitoneoscopic ureterolithotomy operation and found to be quite useful for the mobilisation and extraction of the calculi from the ureters, suggesting its probable use also in the laparoscopic pyelolithotomy procedures.