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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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Eslahi A, Ahmed F, Rahimi M, Jafari SH, Hosseini SH, Al-Wageeh S, Shirazi PMZ, Al-Naggar K, Al-Shami E, Taghrir MH. Outcome of Transperitoneal Laparoscopic Ureterolithotomy (TPLU) for proximal ureteral stone > 15 mm: Our experience with 60 cases. Arch Ital Urol Androl 2021; 93:330-335. [PMID: 34839640 DOI: 10.4081/aiua.2021.3.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. PATIENTS AND METHODS Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. RESULTS The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). CONCLUSIONS TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of medicine, Shiraz University of Medical Sciences, Shiraz; Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz.
| | - Faisal Ahmed
- Urology research center, Al-Thora hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | - Mohammad Rahimi
- Department of Urology, School of medicine, Shiraz University of Medical Sciences, Shiraz.
| | - Seyed Hamed Jafari
- Medical Imagining Research Center, Shiraz University of Medical Sciences, Shiraz.
| | | | - Saleh Al-Wageeh
- Department of General Surgery, Ibb University of Medical Science, Ibb.
| | | | - Khalil Al-Naggar
- Urology research center, Al-Thora hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | - Ebrahim Al-Shami
- Urology research center, Al-Thora hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | - Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz.
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Zia H, Zadeh SST, Khatami F, Aghamir SMK. Laparoscopic ureterolithotomy for large lower ureteral stone: a case series report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Identifying the precise location of the lower ureter is crucial in not only ureteral surgeries but also the other surgeries that may cause ureteral injury. Although a variety of approaches have been applied to detect the location of the lower ureter, the majority of them had an association with several complications or be difficult to perform perfectly or be time-consuming.
Case presentation
Seven patients with distal ureteric stones of the size ranged from 2 to 3 cm. All patients entered the study after signing the informed consent, and the case report is based on CARE guidelines. After specifying the inner ring of the inguinal canal, the posterior peritoneum was opened and dissected from an area of 2 cm medial and 2 cm inferior to the inner ring. Thereafter, the stone was extracted from the precise location of them, which was identified by ureteral pinching.
Conclusion
We assumed that we were easily able to identify the site of the lower ureter through 2 cm medial and 2 cm inferior to the inner ring. The result of our study on seven patients demonstrated that this maneuver can minimize the time of surgery and no complications have been seen while this approach was applied.
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Sharma G, Pareek T, Tyagi S, Kaundal P, Yadav AK, Thummala Y, Devana SK. Comparison of efficacy and safety of various management options for large upper ureteric stones a systematic review and network meta-analysis. Sci Rep 2021; 11:11811. [PMID: 34083725 PMCID: PMC8175352 DOI: 10.1038/s41598-021-91364-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Tarun Pareek
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Shantanu Tyagi
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Pawan Kaundal
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Anuj Kumar Yadav
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Yashasvi Thummala
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Sudheer Kumar Devana
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India.
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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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Won YS, Lee SJ, Kim HY, Lee DS. Five-Year Single Center Experience for Retroperitoneoscopic Ureterolithotomy. J Laparoendosc Adv Surg Tech A 2016; 27:128-133. [PMID: 27768519 DOI: 10.1089/lap.2016.0460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Yong Sung Won
- 1 Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea , College of Medicine, Suwon, South Korea
| | - Seung-Ju Lee
- 2 Department of Urology, St. Vincent's Hospital, The Catholic University of Korea , College of Medicine, Suwon, South Korea
| | - Hee Youn Kim
- 2 Department of Urology, St. Vincent's Hospital, The Catholic University of Korea , College of Medicine, Suwon, South Korea
| | - Dong Sup Lee
- 2 Department of Urology, St. Vincent's Hospital, The Catholic University of Korea , College of Medicine, Suwon, South Korea
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Abstract
Background and Objective: The present study retrospectively analyzed the data of 213 patients who underwent laparoscopic ureterolithotomy. Methods: We retrospectively analyzed the data of 213 patients, in whom we performed conventional laparoscopic ureterolithotomy from April 2006 and January 2015 based on the diagnosis of an upper or middle ureteral stone. Patients with large ureteral stones (>15 mm) or a history of failed shock-wave lithotripsy or ureteroscopy were included in the study. Although the retroperitoneal approach was preferred for 170 patients, the transperitoneal approach was used in the remaining 43 patients. Results: The mean patient age was 39.3 ± 12.0 years (range, 18–73). The study population was composed of 78 (26.7%) female and 135 (63.3%) male patients. The mean stone size was 19.7 ± 2.5 mm. The mean operative time was 80.9 ± 10.9 minutes, and the mean blood loss was 63.3 ± 12.7 mL. Intraoperative insertion of a double-J catheter was performed in 76 patients. The overall stone-free rate was 99%. No major complication was observed in any patient. However, conversion to open surgery was necessary in 1 patient. Conclusion: With high success and low complication rates, laparoscopic ureterolithotomy is an effective and reliable method that ensures quick recovery and may be the first treatment option for patients with large, impacted ureteral stones, as well as for those with a history of failed primary treatment.
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Affiliation(s)
- Selçuk Şahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Bekir Aras
- Department of Urology, Dumlupinar University, Kutahya, Turkey
| | - Mithat Ekşi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nevzat Can Şener
- Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Volkan Tugču
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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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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A comparison of antegrade percutaneous and laparoscopic approaches in the treatment of proximal ureteral stones. BIOMED RESEARCH INTERNATIONAL 2014; 2014:691946. [PMID: 25295266 PMCID: PMC4177728 DOI: 10.1155/2014/691946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.
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Choi H, Kim JH, Park JY, Shim JS, Bae JH. A modified laparoscopic ureterolithotomy by pulling ureter with Carter-Thomason fascial closure and ureter incision by broken 15th blade. Scand J Surg 2014; 103:195-200. [PMID: 24535434 DOI: 10.1177/1457496913509983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS To evaluate the efficacy and safety of a modified laparoscopic ureterolithotomy for the treatment of upper ureteral stones; this method involved the use of a Carter-Thomason fascial closure device, a broken 15th blade. MATERIAL AND METHODS From February 2009 to December 2012, 38 patients with unilateral upper ureteral stones were examined and classified into 2 groups: one group underwent conventional laparoscopic ureterolithotomy (n = 21) and the other group underwent modified laparoscopic ureterolithotomy (n = 17). The modified laparoscopic ureterolithotomy consisted of the use of a Carter-Thomason fascial closure to extract the black silk along with the nylon tape. The ureter incision was made with a modified instrument consisting of a needle holder with a broken 15th blade tip. RESULTS AND CONCLUSIONS Patient demographics were similar in both groups. No significant differences were detected between the conventional laparoscopic ureterolithotomy and modified laparoscopic ureterolithotomy groups with respect to operating time, estimated blood loss, and stone clearance rates. Drain-indwelling times were significantly shorter in modified laparoscopic ureterolithotomy patients than in conventional laparoscopic ureterolithotomy patients (3.2 ± 1.3 vs 4.7 ± 1.5 days). Hospital stay was significantly lesser in modified laparoscopic ureterolithotomy patients than in conventional laparoscopic ureterolithotomy patients (4.3 ± 1.2 vs 5.2 ± 1.2 days). No differences were detected in the ureteral stent indwelling time for the two groups. The use of the Carter-Thomason fascial closure facilitated ureter handling, and the use of a needle holder with a broken 15th blade tip enabled a sharp and precise ureteral incision. Our method allows early removal of the drain and thus earlier patient discharge.
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Affiliation(s)
- H Choi
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - J H Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - J Y Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - J S Shim
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - J H Bae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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Prakash J, Singh V, Kumar M, Kumar M, Sinha RJ, Sankhwar S. Retroperitoneoscopic versus open mini-incision ureterolithotomy for upper- and mid-ureteric stones: a prospective randomized study. Urolithiasis 2013; 42:133-9. [DOI: 10.1007/s00240-013-0624-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 11/06/2013] [Indexed: 11/24/2022]
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Garg M, Singh V, Sinha RJ, Sankhwar SN, Kumar M, Kumar A, Prakash J, Kumar P, Pandey M. Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India. Curr Urol 2013; 7:83-9. [PMID: 24917764 DOI: 10.1159/000356254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 08/08/2013] [Indexed: 11/19/2022] Open
Abstract
AIM Prospective randomized study on transperitoneal laparoscopic ureterolithotomy (TPLU) versus open ureterolithotomy (OU) for treatment of large impacted ureteric stones (≥ 1.5 cm) and assessment of overall results. MATERIAL & METHODS In a prospective study between 2010 to 2012, 30 patients underwent TPLU and 30 OU based on 1:1 randomization. The operation was indicated primarily in 44 cases or after failed shock-wave lithotripsy/ureteroscopy in 16 cases. Two groups were compared for operative time, success rate, visual pain score, analgesic requirement, hospital stay, and postoperative complications. Statistical analysis was performed with SPSS® version 16.0 using Fisher exact or Mann-Whitney U tests with p < 0.05 considered statistically significant. RESULTS The difference in visual pain score (6.2 in TPLU group vs 3.1 in OU group on day 1; 4.8 vs. 2.4 on day 2) and tramadol requirements (184.32 mg in TPLU group vs. 150.87 mg in OU group on day 1; 97.34 mg vs. 65.56 mg on day 2) were statistically significant and more in OU. Hospital stay and convalescence were significantly lower in the TPLU. However, stone removal in one attempt was similar in both the groups. CONCLUSION Although successful stone removal rates are equal in both groups, TPLU is associated significantly with less postoperative pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison to OU.
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Affiliation(s)
- Manish Garg
- Department of Urology, King George Medical University, Lucknow, India
| | - Vishwajeet Singh
- Department of Urology, King George Medical University, Lucknow, India
| | - Rahul J Sinha
- Department of Urology, King George Medical University, Lucknow, India
| | - Satya N Sankhwar
- Department of Urology, King George Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George Medical University, Lucknow, India
| | - Amit Kumar
- Department of Urology, King George Medical University, Lucknow, India
| | - Jai Prakash
- Department of Urology, King George Medical University, Lucknow, India
| | - Pradeep Kumar
- Department of Urology, King George Medical University, Lucknow, India
| | - Mohit Pandey
- Department of Surgery, Era Medical College, Lucknow, 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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Abstract
The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist's armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology.
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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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Bagley DH, Healy KA, Kleinmann N. Ureteroscopic treatment of larger renal calculi (>2 cm). Arab J Urol 2012; 10:296-300. [PMID: 26558040 PMCID: PMC4442915 DOI: 10.1016/j.aju.2012.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 11/26/2022] Open
Abstract
Objectives To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. Methods We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. Results In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23–84)%, 87.1 (79–91)% and 94.4 (90.1–96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2–2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). Conclusions UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist’s options treating renal calculi of >2 cm.
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Affiliation(s)
- Demetrius H Bagley
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kelly A Healy
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nir Kleinmann
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
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Transperitoneal Laparoscopic and Retroperitoneoscopic Stone Treatment. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hammady A, Gamal WM, Zaki M, Hussein M, Abuzeid A. Evaluation of ureteral stent placement after retroperitoneal laparoscopic ureterolithotomy for upper ureteral stone: randomized controlled study. J Endourol 2011; 25:825-30. [PMID: 21457084 DOI: 10.1089/end.2010.0628] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine the necessity of ureteral stent placement after retroperitoneal laparoscopic ureterolithotomy (RLU) for upper ureteral stones more than 1 cm. PATIENTS AND METHODS Between May 2006 and May 2009, 104 RLUs were performed as primary management of large upper ureteral stones. The patients were randomly divided into two groups: In group 1 (52 patients), RLU was performed without stent placement afterward, and in group 2 (52 patients), the stent was placed after RLU. The mean stone size was 16.8 cm in group 1 and 18.2 cm in group 2. The stent in group 2 was placed cystoscopically. RESULTS All procedures were performed successfully. The mean operative time was 48 minutes in group 1 vs. 65 minutes in group 2. The mean drainage time was 4.1 days in group 1 vs. 2.3 days in group 2. All the patients were followed up for a period of 6 months with no recorded cases of residual stone or ureteral stricture. CONCLUSION RLU for large upper ureteral stones could be considered as a primary line for treatment as regards the economic status in developing countries. Laparoscopic ureterolithotomy (LU) without stent placement for upper ureteral stones is safe, cost effective, has less operative time, and needs no auxiliary procedures when compared with the use of stent placement after LU, which adds costs and discomfort for the patient.
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Affiliation(s)
- Ahmed Hammady
- Department of Urology, Sohag University Hospital , Sohag, Egypt.
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Falahatkar S, Khosropanah I, Allahkhah A, Jafari A. Open Surgery, Laparoscopic Surgery, or Transureteral Lithotripsy—Which Method? Comparison of Ureteral Stone Management Outcomes. J Endourol 2011; 25:31-4. [DOI: 10.1089/end.2010.0344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Guilan University of Medical Science, Rasht, Islamic Republic of Iran
| | - Iradj Khosropanah
- Urology Research Center, Guilan University of Medical Science, Rasht, Islamic Republic of Iran
| | - Aliakbar Allahkhah
- Urology Research Center, Guilan University of Medical Science, Rasht, Islamic Republic of Iran
| | - Azadeh Jafari
- Urology Research Center, Guilan University of Medical Science, Rasht, Islamic Republic of Iran
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Ko YH, Kang SG, Park JY, Bae JH, Kang SH, Cho DY, Park HS, Cheon J, Lee JG, Kim JJ. Laparoscopic ureterolithotomy as a primary modality for large proximal ureteral calculi: comparison to rigid ureteroscopic pneumatic lithotripsy. J Laparoendosc Adv Surg Tech A 2010; 21:7-13. [PMID: 21190478 DOI: 10.1089/lap.2010.0340] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To define the role of laparoscopic ureterolithotomy (LU) as a primary modality for large proximal ureteral stones, we compared the outcomes of primary LU with those of ureterorenoscopy (URS), the currently established modality in this circumstance. MATERIALS AND METHODS Among 71 patients who underwent LU in our institution between February 2005 and January 2010, 32 patients with stone size over 1.5 cm who underwent LU as a primary modality without prior shockwave lithotripsy or URS and for whom LU was conducted as a separate procedure were exclusively enrolled. Based on preoperative characteristics of patients and stones, this patient group was matched with the URS group (n = 32, rigid pneumatic lithotripter) during the same period. RESULTS The LU group and the URS group were similar in age, gender distribution, body mass index, stone size (18.1 ± 4.2 versus 17.9 ± 3.6 mm; P = .88), and stone location. Members of the LU group required a longer operative time (118 ± 53 versus 59 ± 41 minutes; P < .001) and hospital stay (5.9 ± 2.1 versus 3.4 ± 2.4 days; P < .001) and had greater blood loss (155 ± 62 mL). However, stone clearance rate (no remnant stone in postoperative X-ray of the kidney, ureter, and bladder) in a single session was marginally higher in the LU group (93.8% versus 68.8%; P = .06). Total complication rate was not significant and was slightly higher in the URS group (12.5% versus 21.9%, P = .51). Stone migration into the kidney (n = 2 versus 5), ureteral perforation (n = 0 versus 3), open conversion (n = 1 versus 2), and ureteral stricture (n = 1 versus 2), as long-term complications, occurred more frequently in the URS group. CONCLUSIONS For large proximal ureteral stones, LU can be conducted safely as a first-line procedure without increase of complication rate, compared with conventional URS. Although LU required a prolonged operative time and a longer hospital stay and blood loss was greater, our data showed an advantage of LU in high clearance rate in a single procedure.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, Korea University School of Medicine, Seoul, Korea
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23
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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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Farooq Qadri SJ, Khan N, Khan M. Retroperitoneal laparoscopic ureterolithotomy--a single centre 10 year experience. Int J Surg 2010; 9:160-4. [PMID: 21059419 DOI: 10.1016/j.ijsu.2010.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/23/2010] [Accepted: 10/22/2010] [Indexed: 11/15/2022]
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.
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Huri E, Basok EK, Uğurlu O, Gurbuz C, Akgül T, Ozgök Y, Bedir S. Experiences in laparoscopic removal of upper ureteral stones: multicenter analysis of cases, based on the TurkUroLap Group. J Endourol 2010; 24:1279-82. [PMID: 20353286 DOI: 10.1089/end.2009.0536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic surgery for ureteral stones was restricted to special cases-those with large or impacted ureteral stones. We present special cases of patients who underwent laparoscopic ureterolithotomy at various clinics in Turkey. PATIENTS AND METHODS Forty-one patients were included in the study from five urology clinics in which laparoscopic surgery was being performed. After a disease-specific history and physical examination, age and sex were recorded. The mean patient age was 41.8 years (30 men and 11 women). Urinalysis, determination of creatinine level, intravenous urography, and ultrasonography were performed. The parameters of stone size, presence of hydronephrosis, previous shockwave lithotripsy, previous ureteroscopic stone therapy, type of laparoscopic approach, operative time, ureteral incision, insertion of a Double-J stent, amount of drainage, hospitalization period, and perioperative complications were evaluated. RESULTS Mean ureteral stone size was 22 mm. The retroperitoneoscopic approach was preferred in 35 (85.3%) patients, while the transperitoneal approach was used in 6 (14.7%) patients. Grade I hydronephrosis was detected in 4 patients, grade 2 in 22 patients, and grade 3 in 12 patients. In six patients, a history of shockwave lithotripsy was confirmed. The ureteral wall was incised with a cold knife in 5, scissors in 16, J-hook in 3, and a monopolar or bipolar dissector in 17 patients. In six patients, a Double-J stent was inserted, while in one patient, the operation was converted to an open procedure. The mean operative time was 124 minutes. The mean amount of drainage was 220 ml. Mean hospitalization time was 4.8 days. In five (12.5%) of seven patients, persistent drainage was a major complication that was managed by insertion of a Double-J stent. All patients were discharged stone free. CONCLUSION Increased hospitalization and operative time can be related to the large stone sizes and prolonged urine leakage. In our opinion, however, the overall success of laparoscopic ureterolithotomy makes it a feasible and effective procedure, especially for stones that could not be managed easily with ureteroscopic stone therapy.
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Affiliation(s)
- Emre Huri
- Department of Second Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey.
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Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: an updated evidence-based review. ACTA ACUST UNITED AC 2010; 38:337-44. [DOI: 10.1007/s00240-010-0275-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/06/2010] [Indexed: 11/24/2022]
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Fan T, Xian P, Yang L, Liu Y, Wei Q, Li H. Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi. J Endourol 2010; 23:1867-70. [PMID: 19811058 DOI: 10.1089/end.2008.0536] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To summarize our experience and evaluate the learning curve of retroperitoneal laparoscopic ureterolithotomy of the upper ureter. PATIENTS AND METHODS Between May 2004 and May 2007, 40 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. We divided the first and last 20 patients into group I and group II. There was no statistical difference in stone size between groups. Operative time and complications were measured as a basis for the assessment of the learning curve. RESULTS In group I, the complication rate was 15% (3/20), including two patients whose procedure was converted to open surgery because of intraoperative bleeding, and one patient who experienced urine leakage because of a displaced Double-J ureteral stent. In group II, no postoperative complications occurred, while the mean operative time was significantly shorter compared with the earlier operations (65 vs 120 min). CONCLUSION Retroperitoneal laparoscopic ureterolithotomy is safe and effective for large or impacted stones of the upper ureter. It is associated with a short learning curve in the setting of an active laparoscopic practice for selected patients.
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Affiliation(s)
- Tianyong Fan
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
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Almeida GL, Heldwein FL, Graziotin TM, Schmitt CS, Telöken C. Estudio prospectivo que compara laparoscopia y cirugía abierta para el tratamiento de cálculos ureterales impactados. Actas Urol Esp 2009; 33:1108-14. [DOI: 10.1016/s0210-4806(09)73189-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hruza M, Schulze M, Teber D, Gözen AS, Rassweiler JJ. Laparoscopic Techniques for Removal of Renal and Ureteral Calculi. J Endourol 2009; 23:1713-8. [PMID: 19785553 DOI: 10.1089/end.2009.1539] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcel Hruza
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Michael Schulze
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Dogu Teber
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Jens Jochen Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
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Khaladkar S, Modi J, Bhansali M, Dobhada S, Patankar S. Which Is the Best Option to Treat Large (>1.5 cm) Midureteric Calculi? J Laparoendosc Adv Surg Tech A 2009; 19:501-4. [DOI: 10.1089/lap.2008.0299] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suparu Khaladkar
- Department of Urology, AMAI Trust's Institute of Urology, Pune, India
| | - Jayesh Modi
- Department of Urology, AMAI Trust's Institute of Urology, Pune, India
| | - Manish Bhansali
- Department of Urology, AMAI Trust's Institute of Urology, Pune, India
| | - Satyen Dobhada
- Department of Urology, AMAI Trust's Institute of Urology, Pune, India
| | - Suresh Patankar
- Department of Urology, AMAI Trust's Institute of Urology, Pune, India
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Bove P, Micali S, Miano R, Mirabile G, De Stafani S, Botteri E, Giampaolo B, Vespasiani G. Laparoscopic Ureterolithotomy: A Comparison Between the Transperitoneal and the Retroperitoneal Approach During the Learning Curve. J Endourol 2009; 23:953-7. [DOI: 10.1089/end.2008.0055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pierluigi Bove
- Department of Urology, Tor Vergata University, Rome, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Miano
- Department of Urology, Tor Vergata University, Rome, Italy
| | | | - Stefano De Stafani
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Edoardo Botteri
- Department of Statistics, European Institute of Oncology, Milan, Italy
| | - Bianchi Giampaolo
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Basiri A, Simforoosh N, Ziaee A, Shayaninasab H, Moghaddam SMMH, Zare S. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: a randomized clinical trial. J Endourol 2009; 22:2677-80. [PMID: 19025388 DOI: 10.1089/end.2008.0095] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Multiple procedures have been introduced for the management of urinary stones in the upper ureter. In this randomized clinical trial, we compared three surgical options in this regard. PATIENTS AND METHODS From September 2004 to May 2006, we enrolled in the study 150 patients with upper ureteral stones who were referred to our center. We included patients with a stone size >or= 1.5 cm in the greatest diameter. Using the random table, patients were divided into three 50-patient groups by treatment: Group A, retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; group B, transperitoneal laparoscopic ureterolithotomy; and group C, percutaneous nephrolithotripsy. All procedures were performed in a training program. RESULTS The stone-free rates for patients in groups A, B, and C, at discharge and 3 weeks later, were 56%, 88% and 64% and 76%, 90% and 86%, respectively. Conversion to open surgery and repeated laparoscopy was necessary for two and one patients in group B. Urinary leakage continued more than 3 days in eight (16%) and nine (18%) patients in groups B and C after operation, respectively (P = 0.7). CONCLUSIONS Although the success rate of ureteroscopy was not significantly lower than the two other options, the complications seen with this technique were negligible. Consequently, the procedure of choice for large proximal ureteral stones seems to depend on surgeon expertise and availability of equipment.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center, Tehran, Iran.
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Mongiat-Artus P, Almeida-Neto D, Meria P, Tariel E, Cortesse A, Desgrandchamps F. Urétérorénoscopie perlaparoscopie dans le traitement des calculs du rein. Prog Urol 2009; 19:21-6. [DOI: 10.1016/j.purol.2008.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 07/06/2008] [Accepted: 07/09/2008] [Indexed: 11/26/2022]
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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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Traxer O, Lechevallier E, Saussine C. [Distal ureteral stone: therapeutic management]. Prog Urol 2008; 18:981-5. [PMID: 19033066 DOI: 10.1016/j.purol.2008.09.016] [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]
Affiliation(s)
- O Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75970 Paris cedex 20, France.
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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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Derouiche A, Belhaj K, Garbouj N, Hentati H, Ben Slama M, Chebil M. L’approche lomboscopique dans le traitement des calculs urétéraux lombaires. Prog Urol 2008; 18:281-7. [DOI: 10.1016/j.purol.2008.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 03/19/2008] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION The increasing spread and technical enhancement of endourological methods has led to displacement of the surgical therapy of renal and ureteral calculi. MATERIALS AND METHODS Based on a review of current literature, we describe indications, technique, and clinical importance of the open and laparoscopic management of urolithiasis. RESULTS In Europe and North America, the surgical therapy of urolithiasis only plays a role in cases of very large or hard stones, after failure of shock wave lithotripsy, percutaneous nephrolithotripsy, or ureteroscopic stone removal, and in cases of abnormal renal anatomy, i.e., only in a few percent of all stone therapies. However, in developing countries and emerging markets with different structure and funding of the health care system where the methods of endourology are not readily available, these techniques still have a higher importance. Particularly in Europe, laparoscopic surgery is emerging because calculi can be removed from almost all locations in the kidney and ureter using a transperitoneal or retroperitoneal access. Functional outcomes and complication rates are comparable. The benefits of laparoscopy are less postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. CONCLUSIONS Although procedures for open and laparoscopic removal of renal and ureteral calculi are only performed in rare cases in daily urological practice, they are superior to the endourological techniques in some circumstances. Therefore, they should still be part of the urologist's skills.
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Kim KS, Sul CK, Lim JS. Efficacy of Laparoscopic Ureterolithotomy for the Upper Ureter Stone. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.8.727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kang Sup Kim
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chong Koo Sul
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
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Abstract
The most important recent advances in the management of ureteral calculi have been the development of medical expulsive therapy to facilitate passage of ureteral stones, such that many calculi that would previously have required procedural treatment now exit the ureter with only pharmacologic treatment; and the improvements in ureteroscopic technology that have enabled retrograde ureteroscopy to become a first-line option for most ureteral stones. Shock wave lithotripsy still plays an important role for many ureteral calculi, particularly smaller ones, and the addition of percutaneous/antegrade ureteroscopy and laparoscopic ureterolithotomy rounds out the treatment options for large or impacted stones. Selection of treatment based upon factors such as size, location, and others will optimize outcome for patients who have ureteral calculi.
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Affiliation(s)
- J Stuart Wolf
- Division of Minimally Invasive Urology, Department of Urology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Abstract
BACKGROUND 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. METHODS 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. RESULTS Ingenious laparoscopic knife has been successfully used in 22 patients with no intraoperative and postoperative complications. CONCLUSION Ingenious laparoscopic knife is cost effective, reliable instrument for ureteric incision during retroperitoneoscopic ureterolithotomy.
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Affiliation(s)
- Rajiv Goel
- Department of Urology, Institute of Kidney Diseases and Research Center, Ahmedabad, India.
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Abolyosr A. Laparoscopic Transperitoneal Ureterolithotomy for Recurrent Lower-Ureteral Stones Previously Treated with Open Ureterolithotomy: Initial Experience in 11 Cases. J Endourol 2007; 21:525-9. [PMID: 17523907 DOI: 10.1089/end.2006.0354] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate transperitoneal ureterolithotomy by laparoscopy (TPUL) for the management of recurrent lower-ureteral stones previously treated with open surgery. PATIENTS AND METHODS Between January 2003 and June 2006, 11 patients (mean age 35.2 years) with recurrent large (mean size 2.8 cm) lower-ureteral calculi and normal renal function underwent TPUL. Seven stones were on the left side, and the remaining four were on the right side. These stones were recurrent after previous open ureterolithotomy. Earlier attempts with ureteroscopy (for three patients) had failed. RESULTS The TPUL was successful in all cases. The mean operating time was 85.2 minutes. Two patients required no narcotic analgesics, while the other patients received a mean of 2.3 10-mg doses of morphine sulfate for postoperative pain relief. The mean hospital stay was 3.8 days. The mean convalescence period was 13.7 days. There were no major intraoperative or postoperative complications. Prolonged urine leakage for 7 and 9 days occurred in two patients, which was managed conservatively. All patients were asymptomatic, stone free, and without obstruction or stricture formation on follow-up that included abdominal ultrasonography and plain films after 6 weeks and intravenous urography after 6 months. There was no deterioration of renal function. CONCLUSIONS Laparoscopic transperitoneal ureterolithotomy is a feasible technique for the management of recurrent lower-ureteral stones after previous open ureterolithotomy that are not amenable to ureteroscopy or SWL. It is a minimally invasive, less-morbid alternative to open transperitoneal ureterolithotomy.
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Affiliation(s)
- Ahmad Abolyosr
- Urology Department, Assiut University Hospital, Assiut, Egypt.
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Wei C, Li-an S, Li Z, Guomin W. Epidural catheters can facilitate laparoscopic placement of ureteral stent: description of a technique. Surg Laparosc Endosc Percutan Tech 2007; 17:120-3. [PMID: 17450094 DOI: 10.1097/sle.0b013e318030484a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To introduce a novel technique for laparoscopic placement of ureteral stent and to investigate the safety and effectiveness of this new method. METHODS Fourteen patients underwent laparoscopic placement of ureteral stents with the technique. The stent was indwelled with an epidural catheter, delivered to the operative field, and placed through the ureteral incision into the renal pelvis and bladder, respectively. The stent was then secured with pincers, while the epidural catheter was removed. RESULTS With this method, the ureteral stent insertion is very convenient and time saving (the mean time for inserting a stent was 2.7 min). The stents were successfully inserted into 13 patients once. One patient underwent insertion of the stent twice intraoperatively. Thirty days after the operations, none of double-J stents had migrated out of the renal pelvis or bladder. CONCLUSIONS This technique is reliable and effective in laparoscopic ureteral operations. Its use should be generalized in laparoscopic ureteral operations.
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Affiliation(s)
- Chen Wei
- Department of Urology, Zhongshan Hospital Fudan University, Shanghai, China
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Skrepetis K, Doumas K. Re: Goel et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol 2005;19:54-57. J Endourol 2006; 20:530-1. [PMID: 16859474 DOI: 10.1089/end.2006.20.530.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mugiya S, Ozono S, Nagata M, Takayama T, Nagae H. Reply by the Authors. Urology 2006. [DOI: 10.1016/j.urology.2006.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
We evaluated the role of retroperitoneal laparoscopic ureterolithotomy (RPLU) for upper ureter stones. Between February 1998 and July 2004, 12 patients (10 men and 2 women) underwent RPLU for upper ureter stones (mean size 18.1 mm, range 10-25). RPLU was carried out in 5 patients as a salvage treatment after failed shock wave lithotripsy (SWL) (3) and both of failed SWL and ureteroscopy (URS) (2), and in 7 patients as primary treatment for large impacted stones. Total 6 of 12 cases were converted to open surgery. The reason of open conversion was failure of locating ureter due to severe adhesion in 5 cases and vascular injury in 1 case. In 6 successful cases, mean operation time, mean estimated blood loss, and mean postoperative hospital stay were respectively 109 min (90-120 min), 50 mL (10-100 mL), 4.6 days (2-7 days). There was no serious postoperative complication except for one patient who showed delayed urinary leakage but was cured with conservative management. Our experience suggested that RPLU was not easy to perform simply because it was indicated mainly in ureter stones with severe adhesion or after failed SWL and/or URS. Nevertheless, it can be considered as a primary procedure before open ureterolithotomy.
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Affiliation(s)
- Byong Chang Jeong
- Department of Urology, Seoul National University Boramae Hospital, Korea
| | - Hyeung Keun Park
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seok Soo Byeon
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Fariña Pérez LA, Pesqueira Santiago D, Meijide Rico F, Zungri Telo ER. [Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years]. Actas Urol Esp 2006; 30:218-21. [PMID: 16700213 DOI: 10.1016/s0210-4806(06)73426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. PATIENT AND METHOD A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. DISCUSSION If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties.
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Kijvikai K, Patcharatrakul S. Laparoscopic ureterolithotomy: Its role and some controversial technical considerations. Int J Urol 2006; 13:206-10. [PMID: 16643610 DOI: 10.1111/j.1442-2042.2006.01277.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Yadav R, Kumar R, Hemal AK. Laparoscopy in the management of stone disease of urinary tract. J Minim Access Surg 2005; 1:173-80. [PMID: 21206660 PMCID: PMC3004119 DOI: 10.4103/0972-9941.19264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/15/2005] [Indexed: 11/04/2022] Open
Abstract
As in other fields of urology, the use of minimally invasive techniques has helped decrease the morbidity and convalescence associated with the management of urolithiasis. Laparoscopy has also been used as one of the minimally invasive techniques. This has developed particularly with the increasing experience and use of intracorporeal suturing techniques. However, in comparison with other surgeries, laparoscopy for stone removal is relatively uncommon and we review the current indications, technical limitation and results.
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Affiliation(s)
- Rajiv Yadav
- Department Of Urology, All India Institute Of Medical Sciences, New Delhi-110029
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Soares RS, Romanelli P, Sandoval MA, Salim MM, Tavora JE, Abelha DL. Retroperitoneoscopy for treatment of renal and ureteral stones. Int Braz J Urol 2005; 31:111-6. [PMID: 15877829 DOI: 10.1590/s1677-55382005000200004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 01/13/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42%) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58%) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71%) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26%) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6%) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94%) became stone free. CONCLUSION Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.
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Affiliation(s)
- Rodrigo S Soares
- Section of Urology, Hospital da Previdência dos Servidores do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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