Effects of Laparoscopic Ureterolithotomy and Simultaneous Trans-Trocar Semi-Rigid Ureteroscopy on Stone-Free Rate in the Treatment of Proximal Ureteral Stones

Abstract

Objective This study presents the effects of the use of semi-rigid ureteroscopy simultaneously during laparoscopic ureterolithotomy on the stone-free rate and, the techniques used to perform laparoscopic ureterolithotomy less invasively. Materials and Methods Between November 2011 and July 2013, laparoscopic ureterolithotomy was performed in 19 patients with proximal ureteral stones. A history of failed shock wave lithotripsy (SWL) or semi-rigid ureteroscopy (sr-URS), presence of ureter stones ≥15 mm and/or impacted stones, or a socioeconomic status not allowing the patient to reach an advanced center for flexible ureteroscopy (f-URS) were identified as the surgical indications. Results Fourteen male (74%) and five female (26%) patients were enrolled in the study and the mean age was 36.4±15.11 (15-70) years. The stones were located on right side in five patients (26%) and left side in 14 patients (74%). The mean stone size was 16.2±3.55 mm (8-22). The mean operation time was 138.9±29.56 minutes (90-200). The mean urethral catheter and drain removal time was 31.2±24.28 (16-120) and 50.8±33.61 hours (18- 168), respectively. There was no postoperative complication in long-term period and stone-free rate was 100%. Conclusion Laparoscopic ureterolithotomy is a feasible alternative in a patient who had previously failed minimally invasive methods and/or with large impacted proximal ureteral stone. Furthermore, to use semi-rigid ureteroscopy during the laparoscopic procedure increases the stonefree rate and prevents the need for an additional procedure in case of concurrent presence of small kidney stones.

Keywords

• Laparoscopy
• ureterolithotomy
• ureteroscopy