Role of laparoscopic ureterolithotomy in stone surgery practice
DOI: 10.22591/magyurol.2023.4.nemethm.186
Authors:
Németh Máté dr., Szepesváry Zsolt Jenő dr., Kerényi Gábor dr.
Petz Aladár Egyetemi Oktató Kórház, Urológiai Osztály, Győr (osztályvezető: Szepesváry Zsolt Jenő dr.)
Summary
Introduction: Treatment options for large upper-middle ureter stones include external shockwave therapy, semirigid ureteroscopy, flexible ureteroscopy, push-back percutaneous nephrolithotripsy (2), laparoscopic ureterolithotomy, open surgical technique, and the “direct puncture” ureterolithotomic technique published by Hungarian urologists and presented at world congresses (3). Each surgical modality has different complication and success rates, as well as different operational device requirement (4). The aim of our study was to analyze laparoscopic ureterolithotomies performed at the Department of Urology of PAEOK between 2012 and 2022, and to compare our results with data reported in international literature.
Material and methods: The data were processed retrospectively. 20 laparoscopic procedures were performed in 20 patients between 2012 and 2022.
Results: In our department, the stone-free rate was 80% after laparoscopic ureterolithotomy during the study period. Surgery was performed transperitoneally in 95% of cases, postoperative ileus did not occur, and conversion to open surgery was not required. In the department, double-J catheters were mostly left behind post-surgery (90%). Urine leakage was encountered in one instance (5%), no ureteral stricture was recorded. The mean surgical time in the transperitoneal approach was 73 minutes, which is significantly less than the data found in literature.
Conclusion: Laparoscopic ureterolithotomy can be performed safely by experienced laparoscopic surgeon, without major perioperative complications (2). In selected cases of impacted, hard, large ureter stones, which are predictably difficult to treat with endourological procedure, laparoscopic ureterolithotomy should be considered as a therapeutic option (9).