Retroperitoneal laparoscopic ureterolithotomy--a single centre 10 year experience

Abstract

Introduction: The management of ureteric stones has standardized with the introduction of ureteroscopy (URS), shock wave lithotripsy(SWL) and HO:YAG laser. But still one may need to use laparoscopic ureterolithotomy for failed URS/SWL cases or as a primary procedure for large impacted stones. At centers which do not have access to expensive equipment needed in URS and SWL, laparoscopic ureterolithotomy may be used as a primary procedure. The aim of this article is to share our 10 year long experience and the lessons learnt from performing retroperitoneal laparoscopic ureterolithotomy (RLU) which we believe is the better route than transperitoneal one.

Methods: From January 2000 to January 2010, 820 cases of ureteric stones were managed at our centre. RLU was performed for 126 cases. Most common indication for RLU was as a primary procedure for large impacted upper or mid ureteric stones 86(68.25%) followed by failed URS in 28(22.23%) and failed SWL in 12(9.52%) cases.

Results: With a mean operative time of 88(45-120) min RLU was successful in 123(97.6%) cases. There was no major intra or postoperative complication. Most common complication of the procedure was the inadvertent peritoneotomy 15(11.9%). Mean hospital stay was 2.8(2-13) days and there were 3(2.38%) cases of prolonged urinary drainage which were managed conservatively.

Conclusion: RLU is a very effective minimally invasive modality of treating ureteral calculi. Unlike URS this procedure can give 100% stone clearance in one session. Its role in advanced urological centers is primarily as a salvage procedure for failed URS/SWL but in developing nations which usually do not have access to URS and SWL RLU can be used as a primary procedure for managing upper and mid ureteric stones with excellent results and with minimal resources.