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Aydin C, Akkoc A, Aydin ZB. How safe and effective is stentless laparoscopic ureterolithotomy in elderly patients? Int J Clin Pract 2021; 75:e14308. [PMID: 33928719 DOI: 10.1111/ijcp.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE With the improvement of minimally invasive urology procedures, open surgical interventions are less common to treat ureteral calculus. Laparoscopic ureterolithotomy (LU) indications are large multiple and/or impacted ureteral calculus that may not be treated with shock-wave lithotripsy or ureterorenoscopy approaches. The aim of our study was to investigate the feasibility and safety of stentless LU in elderly patients. METHODS Between October 2011 and December 2019, 38 geriatric patients underwent stentless transperitoneal LU for upper/mid ureteral calculi. The transperitoneal route was applied in all patients by two surgeons. No double J stent inserted in any patient. The data of all patients reviewed retrospectively. RESULTS The average age was 64.60 ± 3.70 years. The mean calculi size was 19.42 ± 1.41 mm. Ten patients had unsuccessful shock wave lithotripsy or ureterorenoscopy history. The calculi-free rate was 100%. Clavien grade 1 complications were seen in 11 (28.9%) cases. No major perioperative and postoperative complications were encountered. The average length of hospital stay was 3.24 ± 1.53 days. CONCLUSION The significant advances in medical technology and healthcare, lead a rising number of geriatric patients to take benefit of even complicated surgery. Although laparoscopy and its safety in the geriatric population pursues a challenge and the assessment of this procedure is hence obligatory, we think that stentless LU is safe, economical and less uncomfortable for elderly patients.
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Affiliation(s)
- Cemil Aydin
- Department of Urology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
| | - Ali Akkoc
- Department of Urology, Alaaddin Keykubat University School of Medicine, Training and Research Hospital, Alanya, Turkey
| | - Zeynep Banu Aydin
- Department of Radiology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
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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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Abstract
OBJECTIVE We have reviewed the success of laparoscopic calculi surgeries in geriatric patients. METHODS A retrospective analysis was performed on the laparoscopic ureterolithotomy surgeries performed at our central between January 2014 and January 2019 to treat upper ureteral calculi in geriatric patients. Among the patients who underwent these surgeries, we evaluated data on 24 cases whose records could be fully retrieved. RESULTS The age interval of the patients was 60-73 years, and the mean age was 63 ± 3.43 years. The size of the calculi was 19-24 mm, and mean size was 20.2 ± 2.5 mm. Because stone disease was present previously, 5 of these patients underwent endoscopic intervention, whereas two underwent open surgery. Sixteen of these patients had a history of unsuccessful shock wave lithotripsy (SWL) or ureterorenoscopy. The calculi-free rate was 100%. According to the modified Clavien classification, no major perioperative and postoperative complications were observed. The duration of hospital stay was 1-3 days, and the mean duration of stay was 1.6 ± 0.9 days. CONCLUSION We believe that owing to the high success and low complication rates, laparoscopic ureterolithotomy can be the first option of treatment for geriatric patients with impacted large calculi, with a history of unsuccessful SWL or ureterorenoscopy (semirigid, flexible).
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Affiliation(s)
- Aytac Sahin
- Department of Urology, University of Health Sciences Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Serkan Akan
- Department of Urology, University of Health Sciences Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
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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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Soltani MH, Shemshaki H. Stented Versus Stentless Laparoscopic Ureterolithotomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017. [DOI: 10.1089/lap.2017.0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohammad Hossein Soltani
- Endourology Department of Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Hamidreza Shemshaki
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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Magdum PV, Nerli RB, Devaraju S, Hiremath MB. Laparoscopic Ureterolithotomy for Giant Ureteric Calculus: A Case Report. Urol Case Rep 2016; 3:135-7. [PMID: 26793529 PMCID: PMC4672645 DOI: 10.1016/j.eucr.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 11/28/2022] Open
Abstract
We present a case of a 21 year old male who presented with symptomatic right upper ureteric calculus measuring 5 cm × 1.5 cm fulfilling the criteria to be named as giant ureteric calculus. Laparoscopic right ureterolithotomy was performed and the giant ureteric calculus was retrieved.
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Affiliation(s)
- Prasad V Magdum
- KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC, India
| | - Rajendra B Nerli
- KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC, India
| | - Shishir Devaraju
- KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC, India
| | - Murigendra B Hiremath
- KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC, India; PG Department of Biotechnology & Microbiology, Karnatak University, Dharwad, India
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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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You JH, Kim YG, Kim MK. Should we place ureteral stents in retroperitoneal laparoscopic ureterolithotomy?: Consideration of surgical techniques and complications. Korean J Urol 2014; 55:511-4. [PMID: 25132944 PMCID: PMC4131078 DOI: 10.4111/kju.2014.55.8.511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/21/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose There is some debate over the necessity of ureteral stenting after laparoscopic ureterolithotomy. We evaluated the need for ureteral stenting after retroperitoneal laparoscopic ureterolithotomy (RLU). Materials and Methods Between January 2009 and January 2013, 41 patients underwent RLU to remove upper ureteral stones. The retroperitoneal approach was used in all patients by a single surgeon. A double J (D-J) stent was placed in the first 17 patients after the procedure but not in any of the next 24 patients. Results The mean patient age, serum creatinine levels, and stone size were not significantly different between the two groups. The stone-free rate was 100%. The mean operative time was significantly shorter in the stentless group than in the stent group (59.48 minutes vs. 77.88 minutes, p<0.001). Parenteral analgesic use and anticholinergic medication use were observed in the stent group only. The blood loss, drain removal day, and hospital stay were not significantly different between the two groups. No other significant complications occurred during or after the operation in any patients. Conclusions RLU is a safe and effective treatment modality for large impacted ureteral stones. In this study, D-J stent placement was not necessary after RLU. In the future, large-scale studies of RLU without D-J stenting, especially on the frequency of the development of complications according to the surgical technique, may be needed.
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Affiliation(s)
- Jae Hyung You
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Young Gon Kim
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Myung Ki Kim
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Ercil H, Altunkol A, Kuyucu F, Sener NC, Vuruskan E, Ortoglu F, Gurbuz ZG. Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy. Asian J Surg 2014; 38:91-5. [PMID: 25059816 DOI: 10.1016/j.asjsur.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/22/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. MATERIALS AND METHODS The medical data of 50 patients who had undergone retroperitoneal laparoscopic ureterolithotomy between June 2010 and March 2013 were retrospectively analyzed. To assess the learning curve, patients were divided into two groups: Group A (the first 25 cases) and Group B (the last 25 cases). In Group A, double J stents were placed in 17 patients, whereas in Group B 15 patients received double J stents. In Group A, three ports were placed in nine patients and four ports in 16 patients. In Group B, three ports were placed in 20 patients and five patients had four ports. The patients were compared according to demographics, operative time, stone size, complications, hospital stay, and transfusion. RESULTS The mean age for Group A was 47.8 ± 14.13 (21-72) years and that for Group B was 44.2 ± 14.98 (22-78) years. Mean operative times were 106.4 ± 38 (55-210) minutes and 70.76 ± 30.4 (30-180) minutes for Groups A and B, respectively (p < 0.05). The mean hospital stay was 7.12 ± 4.47 (3-22) days and 4.04 ± 2.05 (2-12) days for Groups A and B, respectively (p < 0.05). The mean stone size was 20.12 ± 5.18 (12-30) mm and 19.44 ± 4.44 (13-28) mm for Groups A and B, respectively (p > 0.05). CONCLUSION In our study, as staff experience (in performing laparoscopic retroperitoneal ureterolithotomy) increased, operative time, length of hospital stay, and complication rates have correspondingly declined.
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Affiliation(s)
- Hakan Ercil
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adem Altunkol
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey.
| | - Faruk Kuyucu
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Nevzat Can Sener
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ediz Vuruskan
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ferhat Ortoglu
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Zafer Gokhan Gurbuz
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
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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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Chen IH, Tsai JY, Yu CC, Wu T, Huang JK, Lin JT. Ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy. Kaohsiung J Med Sci 2013; 30:243-7. [PMID: 24751387 DOI: 10.1016/j.kjms.2013.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/08/2013] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to examine the feasibility of ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy and to evaluate the effects of retrograde ureteroscopic access exerted on the sutured ureterotomy site. From January 2002 to December 2011, 30 patients with proximal ureteral stone underwent ureteroscopic double-J stenting of the ureter following retroperitoneal laparoscopic ureterolithotomy. Patient demographics and perioperative parameters, including the degree of hydronephrosis, urine leakage, and drainage time, were retrospectively reviewed. These data were compared with those of 30 consecutive patients who received open ureterolithotomy and intracorporeal ureteral double-J stenting. In addition, a PubMed search was conducted and the related literature on the placement of a ureteral stent was reviewed. Twenty-eight patients successfully underwent ureteral double-J stenting with ureteroscopic access. No malposition of the ureteral stent was identified in the ureteroscopic group, but two patients in the intracorporeal group required postoperative adjustment of the stent. Residual stone fragments were found during stent placement in three patients in the ureteroscopic group and holmium:yttrium-aluminum-garnet laser lithotripsy was immediately performed. There was no significant difference in postoperative outcomes or complication rates between the two groups. Ureteroscope-assisted ureteral double-J stenting is a simple and safe alternative allowing intraluminal navigation along the entire ureter, correct stent placement, and prompt treatment of residual stone fragments, without radiation exposure. In addition, ureteral disruption and urinary extravasation may not be concerns for ureteroscopic access with continuous normal saline irrigation.
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Affiliation(s)
- I-Hsuan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jeng-Yu Tsai
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Cheng Yu
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tony Wu
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jong-Khing Huang
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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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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Karami H, Javanmard B, Hasanzadeh-Hadah A, Mazloomfard MM, Lotfi B, Mohamadi R, Yaghoobi M. Is it necessary to place a Double J catheter after laparoscopic ureterolithotomy? A four-year experience. J Endourol 2012; 26:1183-6. [PMID: 22540150 DOI: 10.1089/end.2012.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the necessity of placing a ureteral stent after transperitoneal laparoscopic ureterolithotomy (TPLU). PATIENTS AND METHODS In the period from May 2006 to November 2010, 46 patients underwent TPLU. There were 13 females and 33 males. All patients had an impacted stone larger than 1.5 cm in the upper and middle parts of the ureter. TPLU was performed as either a primary therapy or as a salvage therapy in patients in whom another treatment had failed. The exclusion criteria were pregnancy, a body mass index more than 35, and patients with abnormal results on coagulative tests. In all cases, after removing the stone, the ureter was sutured. In the first 23 patients, no ureteral catheter was placed, but in the second 23 patients, a Double J catheter was inserted through the ureter. RESULTS In one case, the stone was pushed back. The stone-free rate was 97.8%. There were four cases of prolonged urinary leakage after the surgery. All of them were in the group in whose members the Double J catheter had not been placed. The problem was resolved in one patient spontaneously after 4 days, but for the other three patients, a Double J catheter was placed and the leakage was stopped in 24 hours. There was no case of urinary leakage in the second group of patients with a placed Double J catheter. CONCLUSION Placing a Double J catheter during surgery does not increase the time of operation and may play a role in prevention of urinary extravasation after laparoscopic ureterolithotomy.
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Affiliation(s)
- Hossein Karami
- Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, I.R. Iran.
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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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Okhunov Z, Duty B, Smith AD, Okeke Z. Management of urolithiasis in patients after urinary diversions. BJU Int 2011; 108:330-6. [DOI: 10.1111/j.1464-410x.2011.10194.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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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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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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Borges Matias D, Gonçalves Alvim R, Ribas M, Pierote de Oliveira B, Torres Chaves OH. Tratamiento laparoscópico de la ureterolitiasis: nuestra experiencia. Actas Urol Esp 2009; 33:667-9. [DOI: 10.1016/s0210-4806(09)74205-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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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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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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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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40
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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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41
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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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Nouira Y, Kallel Y, Binous MY, Dahmoul H, Horchani A. Laparoscopic retroperitoneal ureterolithotomy: initial experience and review of literature. J Endourol 2005; 18:557-61. [PMID: 15333221 DOI: 10.1089/end.2004.18.557] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the place of retroperitoneal laparoscopic ureterolithotomy in the management of ureteral calculi through an initial experience and review of previously reported cases. PATIENTS AND METHODS Laparoscopic ureterolithotomy was attempted in six patients (five men and one woman) with an age of 31 to 56 years (mean 41.5 years) who had large and impacted stones in the upper ureter. The stone size ranged from 18 to 40 mm (mean 25.7 mm). The retroperitoneal route was used in all cases. RESULTS The stone was removed in all but one case. The operative time ranged from 120 to 180 minutes (mean 160 minutes). No intraoperative complications were encountered. Postoperative complications included prolonged urinary leak in one patient. On follow-up, all patients were stone free with decompression of the upper urinary tract. CONCLUSIONS Laparoscopic ureterolithotomy is safe and effective and should be performed each time a ureterolithotomy is indicated.
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Affiliation(s)
- Yassine Nouira
- Department of Urology, La Rabta Hospital, Tunis, Tunisia
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44
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Goel A, Hemal AK. Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with percutaneous nephrolithotripsy. Int Urol Nephrol 2004; 35:73-6. [PMID: 14620289 DOI: 10.1023/a:1025962009286] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate the role of retroperitoneoscopic pyelolithotomy (RPPL) for the management of renal pelvic calculus and its comparison with percutaneous nephrolithotripsy (PCNL). PATIENTS AND METHODS Eighteen RPPLs were performed between March 1995 and March 2002, and 16 out of these were compared retrospectively with 12 cases of PCNL performed in the year 2000 for solitary renal pelvic stone more than 3-cm in size. Laparoscopic pyelolithotomy was carried out with retroperitoneal approach and subsequent to stone removal pyelotomy was sutured with intracorporeal interrupted sutures. RESULTS The two groups were similar as regards the patient age and sex. The mean stone sizes in RPPL and PCNL groups were 3.6 and 4.2 cm respectively (p < 0.006). There were 2 conversions in the RPPL group due to stone migration into calyx and dense perirenal adhesions making dissection difficult. The mean operating time was 142.18 min for RPPL as compared to 71.6 min for PCNL (p < 0.000). The blood loss was 173.1 ml in RPPL as compared to 147.9 ml for PCNL (p NS). The mean hospital stay was 3.8 and 3-days in RPPL and PCNL groups respectively. CONCLUSIONS Laparoscopic pyelolithotomy takes longer to perform, more invasive, less cosmetic and requires more skills at present as compared to PCNL. In this limited study it is clearly demonstrated that PCNL is the better treatment modality for renal stones and laparoscopy should be offered to those who needs adjunctive procedure such as pyeloplasty or puncture during PCNL under vision.
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Affiliation(s)
- Apul Goel
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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46
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Abstract
At this moment in time, endourology is incorporating extraluminal endoscopic techniques (laparoscopy, lumboscopy, retziuscopy), which the urologist is expected to master. The current advanced stage of development of intraluminal endoscopic surgery is mainly due to the most recent technological achievements (miniaturization of the lens, the use of more versatile materials and new energy sources). In the current cystourethroscopic procedures, compact endoscopes and flexible cystoscopes play an important role. The most important of these new techniques include tissue vaporisation procedures, interstitial application of substances or energies, low-pressure transurethral resection and percutaneous vesical surgery. Upper endoluminal procedures have been the ones to most benefit from modern technological developments. The most important features of present day ureterorenoscopes and their clinical applications are studied and also those of percutaneous nephroscopy (lithiasis, neoformations and others). In a review on the current situation of extraluminal endoscopy, a wide range of laparoscopic techniques--applicable to adrenal regions, kidneys, ureters, retroperitoneal and lymphatic systems, testicles and sperm ducts, bladder and prostrate gland--are discussed as well as the indications, advantages and drawbacks involved and the preferential surgical approaches.
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Affiliation(s)
- J G Valdivia Uría
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza
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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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48
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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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49
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Goel A, Hemal AK. Upper and mid-ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy. BJU Int 2001; 88:679-82. [PMID: 11890236 DOI: 10.1046/j.1464-4096.2001.00150.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the results with those from open surgery. PATIENTS AND METHODS Between March 1994 and mid-December 2000, 55 patients with large (mean 2.1 cm) upper and mid-ureteric calculi, and with normal renal values, underwent RPUL. In 22 patients, earlier attempts with extracorporeal shock wave lithotripsy and ureteroscopy had failed. These patients were compared with 26 (mean stone size 2.4 cm) who underwent open ureterolithotomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location; most stones were calcium-based. RESULTS The mean operative duration and blood loss for RPUL and open surgery were 108.8 and 98.8 min, and 58.5 and 50.5 mL, respectively (not significant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P<0.001). The duration of convalescence was significantly less after RPUL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which occurred early in the series, and one significant complication amongst patients who underwent RPUL. CONCLUSIONS RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid-ureteric calculi and in those patients where a previous attempt at endourological management has failed. However, the technique requires significant training and experience before good results can be obtained.
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Affiliation(s)
- A Goel
- Department of Urology, All India Institute of Medical Sciences, New Delhi
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50
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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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