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Bilateral Synchronous 3-Port Trans-peritoneal Laparoscopic Ureterolithotomy: a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:109. [PMID: 35694451 PMCID: PMC9172089 DOI: 10.1007/s42399-022-01190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/06/2022]
Abstract
Trans-peritoneal laparoscopic ureterolithotomy is a well-established minimally invasive procedure for management of large impacted ureteric stones since the last 3 decades. We present a case of a 51-year old gentleman, who presented with bilateral large upper ureteric calculi with obstructive uropathy and azotemia, managed successfully with bilateral synchronous 3-port trans-peritoneal laparoscopic ureterolithotomy, and to our knowledge is the first such case to be reported in literature.
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BAHÇECİ T. Urological laparoscopic procedures and results performed by a single urologist in a secondary state hospital. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1127748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: To evaluate the results of urological laparoscopic operations performed by a single surgeon in secondary public hospital
Materials and Methods: The data of 30 patients who underwent urological laparoscopic surgery in Şanlıurfa Training and Research Hospital between January 2018 and January 2021 were retrospectively analyzed. The operation type, duration of operation, side, removal time of drain, length of stay in the hospital and complications were noted.
Results: All patients underwent laparoscopy via transperitoneal route. Laparoscopic nephrectomy was performed in 15 patients, dismembred pyeloplasty in 4 patients, ureterolithotomy in 8 patients, and cyst excision in 3 patients. The mean patient age was 40.43 + 16.72 (14-76). A male/female ratio of 13/17 was found to be 43.3% male and 56.7% female. Considering the operation times, nephrectomy was 173.26 (120-240) minutes, pyeloplasty 240 ± (210-270) minutes, ureterolithotomy 110.75 (75-180) minutes, and cyst excision 112.66 (100-138) minutes. All patients had a trace amount of drains (
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Affiliation(s)
- Tuncer BAHÇECİ
- Şanlıurfa Eğitim ve Araştırma Hastanesi, Şanlıurfa, Türkiye
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Ali AI, Abdel-Karim AM, Abd El Latif AA, Eldakhakhny A, Galal EM, Anwar AZ, El-Hawy MM, Fathelbab TKH, Elbadry MS, Elsharkawy MS, Tawfiek ER. Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0003-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Different treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid ureteroscopy and holmium laser lithotripsy (Group A) and 30 patients had laparoscopic ureterolithotomy (Group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, postoperative complications and stone-free rate.
Results
The mean stone size was 1.84 ± 0.12 cm in Group A and 1.79 ± 0.17 cm in Group B, P value = 0.2. The mean operative time was 61.5 ± 3.5 min in Group A and 63 ± 4.2 min in Group B, P value = 0.13. Stone migration was recorded in five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group.
Conclusion
The stone-free rates after semirigid URS and laser lithotripsy are comparable to those following LU, especially when flexible URS is used to manage migrating stone fragments at the same session.
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Wani MM, Durrani AM. Laparoscopic ureterolithotomy: Experience of 60 cases from a developing world hospital. J Minim Access Surg 2018; 15:103-108. [PMID: 29737311 PMCID: PMC6438065 DOI: 10.4103/jmas.jmas_203_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Laparoscopic ureterolithotomy, which has been quoted to have a success rate equivalent to open ureterolithotomy for uretric stones, can be performed transperitoneally and retroperitoneally. The aim of the present study is to report our experience with laparoscopic retroperitoneal ureterolithotomy, its results and advantages in the current era of minimally invasive surgery in a developing country. Patients and Methods It was a prospective study carried from May 2010 to December 2012. 60 patients diagnosed with upper and middle uretric calculi, with sizes more than 1 cm and with value of more than 1500 hu on CT Urography ,underwent laparoscopic retroperitoneal ureterolithotomy. Results All patients underwent retroperitoneal laparoscopic ureterolithotomy successfully. The mean operative time was 64.53 min. The mean blood loss was 39.83 ml. 3 patients had minor intra-operative complications which were tackled on table. Post-operative complications developed in 3 patients, all minor. There were no major complications. The removal of drain was at (2.7 days). Mean hospital stay was of 3.3 days. Patients reported to their routine activities in 1.78 weeks. During follow-up 3 months later, CT urography revealed normal ureter in all cases. Conclusion Laparoscopic retroperitoneal ureterolithotomy has low rate of conversion to open surgery and an acceptable overall complication rates. In selected patients with impacted, hard, large ureteral stones, which are likely to cause diffi-culty in endo-urological procedures, laparoscopic ureterolithotomy is a reason-able treatment option.
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Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol 2017; 17:50. [PMID: 28662708 PMCID: PMC5492714 DOI: 10.1186/s12894-017-0236-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background There 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. Methods Between 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. Results Fifteen 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). Conclusions MPCNL 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 registration This study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR-INR-17011507; Registration date: 2017–5-22).
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Affiliation(s)
- Yunyan Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Bing Zhong
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Xiaosong Yang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Gongcheng Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Peijin Hou
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Junsong Meng
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China.
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Yüksel ÖH, Ötünçtemur A, Özbek E, Uruç F, Verit A. Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve? Int Braz J Urol 2016; 41:707-13. [PMID: 26401863 PMCID: PMC4756999 DOI: 10.1590/s1677-5538.ibju.2014.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/28/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose: The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated. Materials and Methods: A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study. Results: Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively. Conclusion: We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.
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Affiliation(s)
- Özgür Haki Yüksel
- Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Alper Ötünçtemur
- Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Emin Özbek
- Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Fatih Uruç
- Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Ayhan Verit
- Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
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Khalil M, Omar R, Abdel-Baky S, Mohey A, Sebaey A. Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach? Turk J Urol 2015; 41:185-90. [PMID: 26623147 DOI: 10.5152/tud.2015.03442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. MATERIAL AND METHODS A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed. RESULTS There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. CONCLUSION Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.
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Affiliation(s)
| | - Rabea Omar
- Department of Urology, Benha University, Benha, Egypt
| | | | - Ahmed Mohey
- Department of Urology, Benha University, Benha, Egypt
| | - Ahmed Sebaey
- Department of Urology, Benha University, Benha, Egypt
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Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience. J Endourol 2014; 29:1248-52. [PMID: 25177768 DOI: 10.1089/end.2013.0791] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS AND OBJECTIVES The optimal management method of upper ureteral stones >2 cm is still a challenge. We performed a prospective randomized comparison between laparoscopic ureterolithotomy (LU) and ureteroscopic lithotripsy for upper ureteral calculus >2 cm to evaluate safety and efficacy of both procedures. MATERIALS AND METHODS Between January 2010 and May 2012, 110 patients with a single radiopaque upper ureteral calculus >2 cm were included in the present study. Randomization was done in two groups-group A: LU was performed and group B: Ureteroscopy (URS) was performed using a 6/7.5F semirigid ureteroscope (Richard Wolf) with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success, retreatment, auxiliary procedure rates, and also complications. RESULTS Out of the total 110 patients, 54 patients were enrolled in group A and 56 patients were enrolled in group B. Mean stone size was 2.3±0.2 cm in group A versus 2.2±0.1 cm in group B (p=0.52). The overall 3-month stone-free rate was (50/50) 100% for group A versus (38/50) 76% for group B (p=0.02). The retreatment rate was significantly greater in group B than group A (8% vs. 0%, respectively; (p=0.01). Auxiliary procedure rate was higher in group B than in group A (26% vs. 0% respectively; p=0.001). The complication rate was 12% in group A versus 26% in group B (p=0.001). CONCLUSIONS For upper ureteral stones of size greater than 2 cm, LU has a greater stone clearance rate, comparable operating time, lesser need for auxiliary procedure, and complication rate as compared to URS.
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Affiliation(s)
- Anup Kumar
- Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India
| | - Pawan Vasudeva
- Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India
| | - Biswajit Nanda
- Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India
| | - Niraj Kumar
- Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India
| | - Sanjeev Kumar Jha
- Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India
| | - Harbinder Singh
- Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India
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Nasseh H, Pourreza F, Kazemnejad Leyli E, Zohari Nobijari T, Baghani Aval H. Laparoscopic transperitoneal ureterolithotomy: a single-center experience. J Laparoendosc Adv Surg Tech A 2013; 23:495-9. [PMID: 23597187 DOI: 10.1089/lap.2012.0187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate success and complications of laparoscopic transperitoneal ureterolithotomy at our center. PATIENTS AND METHODS From November 2008 until September 2011, 33 patients, including 22 men and 11 women, with a mean age of 45.3 years (range, 19-67 years), underwent laparoscopic ureterolithotomy at our center. Locations of stones were the upper, middle, and lower ureter in 29, 1, and 3 patients, respectively. Ten patients had a history of previous abdominal or pelvic surgery. Laparoscopic ureterolithotomy was performed via a transperitoneal approach. Complications and outcomes were evaluated. RESULTS Mean operation time was 85.48±15.11 minutes. Except for one stone migration and one conversion to open surgery, all the ureteral stones were extracted laparoscopically (94% success rate). A double J stent was inserted antegradely during the procedure and remained for about 1 month in all cases except in 1 patient in whom both antegrade insertion and ureteroscopic relocation were used. Postoperative hypercapnia was detected in a young patient, who recovered with conservative treatment. No visceral complication occurred. The mean hospital stay and the drain installation interval were 4.1 days (range, 3-9 days). The mean return to full activity was 11.91±4.65 days. Preoperative hydronephrosis resolved at follow-up ultrasonography (3 months later) in all patients except 2 cases, in whom intravenous pyelography showed no obstruction (memorial hydronephrosis). CONCLUSIONS Laparoscopic transperitoneal ureterolithotomy is a safe and effective treatment modality for skilled surgeons and a convenient option for patients. Challenges, such as lower ureteral stones, redo cases, and antegrade double J stent insertion, can be overcome by experience.
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Affiliation(s)
- Hamidreza Nasseh
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Singh V, Sinha RJ, Gupta DK, Kumar M, Akhtar A. Transperitoneal versus retroperitoneal laparoscopic ureterolithotomy: a prospective randomized comparison study. J Urol 2012; 189:940-5. [PMID: 23023151 DOI: 10.1016/j.juro.2012.09.114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE We compared laparoscopic transperitoneal and retroperitoneal ureterolithotomy approaches, and determined whether one technique is superior to the other. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Vishwajeet Singh
- Department of Urology and the Department of Psychiatry (AA), C.S.M. Medical University (Upgraded King George Medical College), Lucknow, Uttar Pradesh, India.
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Laparoscopic ureterolithotomy: minimally invasive second line treatment. Int Urol Nephrol 2010; 43:651-4. [DOI: 10.1007/s11255-010-9872-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
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Saussine C, Lechevallier E, Traxer O. Lithiase urinaire et laparoscopie. Traitement des calculs situés dans l’uretère. Prog Urol 2008; 18:943-7. [DOI: 10.1016/j.purol.2008.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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El-Moula MG, Abdallah A, El-Anany F, Abdelsalam Y, Abolyosr A, Abdelhameed D, Izaki H, Elhaggagy A, Kanayama HO. Laparoscopic ureterolithotomy: our experience with 74 cases. Int J Urol 2008; 15:593-7. [PMID: 18479354 DOI: 10.1111/j.1442-2042.2008.02065.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We retrospectively evaluated our experience with a relatively uncommon procedure, the laparoscopic ureterolithotomy, for the treatment of ureteral stones. METHODS Between April 2002 and October 2006, a total of 74 patients (56 males, 18 females) with upper (54 cases), middle (18 cases) and lower (two cases) ureteral stones underwent laparoscopic ureterolithomy. The mean age was 39.4 years (range, 19-74). The stones were in the right side in 44 cases (59.5%) and in the left side in 30 (40.5%) cases. The mean stone size was 1.8 cm (range 1.5-2.8). The procedure was retroperitoneal in 66 cases (89.2%) and transperitoneal in eight (10.8%) cases. Laparoscopic guided flexible ureterorenoscopic extraction of kidney stone was carried out in one case as an adjuvant procedure. The ureter was stented and not sutured in 64 cases (86.5%). RESULTS The procedure was successfully completed in 94.6% of cases and an open conversion was carried out in four (5.4%) patients. The mean operative time was 58.7 min, and the mean blood loss was 90.6 mL. No major complications were encountered. Prolonged urinary leakage occurred in one patient. The mean hospital stay was 6.4 days. One patient developed ureteral stricture during follow up and was treated by endoscopic dilatation and stenting. CONCLUSION In our experience laparoscopic ureterolithotomy represents a safe and effective treatment option for ureteral stones either as primary for large impacted stones or as a salvage procedure after failed shock wave lithotripsy or ureteroscopy. This procedure fulfills the advantages of minimal blood loss and analgesia requirements, good cosmetic appearance, short hospital stay and convalescence period.
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Lee YS, Lee DH, Han WK, Kim HJ, Yang SC, Rha KH. Laparoscopic Ureterolithotomy has a Role for Treating Ureteral Stones. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.5.498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong Seong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jun Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Kim MS, Moon YT. Video Assisted Minilaparo-Ureterolithotomy in 36 Upper Ureteral Calculi. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.6.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Min Su Kim
- Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Young Tae Moon
- Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea
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Abstract
The contemporary management of ureteric stones is reviewed and evidence based recommendations about treatment are made. Stones measuring less than 4mm in diameter have a high chance of spontaneous passage and the main debate for optimum treatment of larger stones centres around the choice of shock wave lithotripsy or endoscopic management combined with laser fragmentation. Treatment recommendations should be based on patient preference, published evidence, local audit (surgeon expertise and availability of equipment) and cost. Artificial Neural Networks could become a useful tool for prediction of treatment outcome for ureteric stones, and further research is needed to clarify this potential. ESWL is less effective than ureteroscopy but it may prevent the need for more invasive treatment in a substantial proportion of patients. It should only be considered as initial treatment in patients with stones less than 10mm in size. The routine use of stents should be avoided as both fragmentation and stone free rates are noticeably lower. For larger stones, initial laser ureteroscopy serves better both for proximal or distal calculi and is more cost-efficient. Provided that no contraindications for general anaesthesia exist, laser ureterolithotripsy should be regarded as an excellent first line treatment modality for ureteric stone especially in greater stone burden. In the best hands, the outcome for endoscopic management of ureteric stone in all sites is better than ESWL and is cheaper, although equipment, expertise and experience are all required to achieve this superior outcome.
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Affiliation(s)
- Theodore Anagnostou
- The Scottish Lithotriptor Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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Gaur DD, Trivedi S, Prabhudesai MR, Madhusudhana HR, Gopichand M. Laparoscopic ureterolithotomy: technical considerations and long-term follow-up. BJU Int 2002; 89:339-43. [PMID: 11872020 DOI: 10.1046/j.1464-4096.2001.01562.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyse the technical details and the long-term results of laparoscopic ureterolithotomy. PATIENTS AND METHODS Laparoscopic ureterolithotomy was undertaken in 101 patients between 1991 and 2001; in only one patient with retroperitoneal fibrous adhesions was the procedure transperitoneal, being retroperitoneal in all the others, using Gaur's balloon retroperitoneoscopy. The mean (range) stone size was 16 (10-47) mm, and the stones were in the upper ureter in 75, mid-ureter in 11 and lower ureter in 15 patients. Nine patients had more than one stone, the maximum being six, in a megaureter. Most were impacted for > 2 months, the maximum being 240 months. RESULTS Laparoscopic ureterolithotomy was successful in 93 patients, with the eight failures being mostly early in the series. The mean operative duration was 79 min (66 min when the ureter was left open and 92 min when it was sutured). The overall mean duration of urinary leakage was 5.5 days, which was reduced to 3.2 days by stenting and suturing the ureter. The mean (range) blood loss was 25 (5-100) mL. The overall complication rate was high (31%) because of prolonged urinary leakage in 20 patients. No patient required morphine for pain relief and the mean for oral analgesic use was 2.5 days. The mean hospital stay was 3.5 days and that for resuming work 14 (7-28) days. CONCLUSIONS Laparoscopic ureterolithotomy by the retroperitoneal approach is a safe and reliable minimally invasive procedure. Although its role as a salvage procedure for failed extracorporeal shock wave lithotripsy and ureteroscopy is undisputed, in selected patients with large chronically impacted ureteric stones and particularly with solitary kidneys, it may be considered the first-line treatment.
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Affiliation(s)
- D D Gaur
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Bombay, India
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Abstract
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.
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Affiliation(s)
- I Gülmez
- Erciyes University, Medical Faculty, Department of Urology, Kayseri, Turkey
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Rofeim O, Yohannes P, Badlani GH. Does laparoscopic ureterolithotomy replace shock-wave lithotripsy or ureteroscopy for ureteral stones? Curr Opin Urol 2001; 11:287-91. [PMID: 11371782 DOI: 10.1097/00042307-200105000-00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ureteral stones are a major cause of morbidity and anxiety among urologic patients. Before the 1980s, ureteral stones were managed by open ureterolithotomy. Since then, second- and third-generation shock-wave lithotriptors, small-caliber ureteroscopes, and laparoscopic procedures have evolved as options for the treatment of ureteral calculi. Each technique is highly effective when implemented for the appropriate indication. Stone size, location, composition, and surgeon's and patient's preferences each play a major role in the decision-making process. Currently, ureteroscopy and shock-wave lithotripsy are regarded by many as the first-line treatment modalities for the management of ureteral stones, and the exact role of laparoscopic ureterolithotomy remains poorly defined. The present review addresses the most recent literature, and highlights the advantages and disadvantages of each surgical option.
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Affiliation(s)
- O Rofeim
- Departments of Urology, Albert Einstein College of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
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Keeley FX, Gialas I, Pillai M, Chrisofos M, Tolley DA. Laparoscopic ureterolithotomy: the Edinburgh experience. BJU Int 1999; 84:765-9. [PMID: 10532968 DOI: 10.1046/j.1464-410x.1999.00287.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review our experience with laparoscopic ureterolithotomy. PATIENTS AND METHODS Since 1993, we have performed laparoscopic ureterolithotomy in 14 patients with ureteric stones. Laparoscopy was carried out in nine patients as a salvage procedure after failed ureteroscopy (six), shock wave lithotripsy (two), or both (one), and in five patients as a primary procedure for large stones (mean 27.2 mm, range 18-40). Patients in the former group had already undergone a mean of 1.88 procedures (range 1-4). Laparoscopic ureterolithotomy was carried out via a transperitoneal approach. Associated ureteric strictures were incised at the time of ureterotomy. RESULTS All procedures were completed laparoscopically and all patients were rendered stone-free after a single procedure. The mean operative duration was 105 min. Ureteric strictures were incised in three patients, in two of whom dilatation was subsequently required; all three had a successful result. There were three minor complications. CONCLUSIONS Laparoscopic ureterolithotomy can be a safe and effective procedure; it should be considered as a primary procedure for large mid- and upper ureteric stones.
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Hsu YS, Chiu AW, Chen KK, Chang LS. Inadvertent puncture of the kidney by a trocar during retroperitoneo-scopic ureterolithotomy. MINIM INVASIV THER 1998. [DOI: 10.3109/13645709809152865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sinha R, Sharma N. Retroperitoneal laparoscopic management of urolithiasis. J Laparoendosc Adv Surg Tech A 1997; 7:95-8. [PMID: 9459808 DOI: 10.1089/lap.1997.7.95] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic retroperitoneal pyelolithomy (Lap PL) and ureterolithotomy (Lap UL) were performed in 20 and 24 patients, respectively. The average operating time was 61.4 minutes for Lap UL and 80.2 minutes for Lap PL. The conversion rate for Lap PL was 4 (20%) patients, and none of the Lap ULs required conversion. There were no major postoperative complications, except prolonged tube drainage in 2 patients, and the average hospital stay was 3.6 days.
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Affiliation(s)
- R Sinha
- Department of Surgery, Maharani Laxauri Bai, Medical College, Jhansi, India
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Abstract
The management of ureteral stones has undergone revolutionary changes in the past 15 years. The parallel advances in extracorporeal shock wave lithotripsy, percutaneous and retrograde endoscopic access to the collecting system, and intracorporeal lithotripsy devices almost completely have supplanted the need for a traditional ureterolithotomy. The merits of the various technologies that are available are discussed as they apply to treating calculi in different ureteral segments.
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Affiliation(s)
- R K Singal
- Division of Urology, University of Western Ontario, London, Canada
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Matsuda T, Terachi T, Yoshida O. Laparoscopy in urology: present status, controversies, and future directions. Int J Urol 1996; 3:83-97. [PMID: 8689517 DOI: 10.1111/j.1442-2042.1996.tb00489.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- T Matsuda
- Department of Urology, Kansai Medical University, Moriguchi, Japan
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