Abstract
Objectives: To evaluate the efficacy and safety of laparoscopic transperitoneal ureterolithotomy for management of large proximal ureteric stones. Materials and
Methods: Medical records of patients who underwent laparoscopic transperitoneal ureterolithotomy for proximal ureteral stones = 2 cm were reviewed retrospectively. Patients' characteristics, stone characteristics, perioperative and follow-up data were studied. Patients with stones < 2 cm in size, previous transperitoneal surgical procedure, or follow-up duration < 6 months were excluded from the study.
Results: Twelve patients (mean age = 52.9 +/- 12 years) with large upper ureteric stones (mean stone largest diameter = 39 +/- 13 mm) were included. Nine patients had single stone, 2 patients had two stones, and 1 patient had large impacted stone with 2 small stones floating above. Mean operative time was 107 +/- 49.5 min with mean blood loss of 60.5 +/- 19.2 cc. Mean total pain score was 38.4 +/- 5.5 (100 point scale) and mean time till resuming oral intake was 3.6 +/- 0.5 h. Mean duration of hospital stay was 2.6 +/- 1.4 days and mean duration of stenting was 7.3 +/- 2 weeks. Throughout a mean duration of follow-up of 14.8 +/- 7.6 months, 100% stone clearance rate was achieved with no recurrence. One patient developed a ureteric stricture treated by laser endoureterotomy and stenting for 6 weeks and responded without re-stricture formation.
Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.