Laparoscopic ureterolithotomy - alternative for open access operation
Article published in Urologia Polska 2004/57/3.

authors

Marcin Słojewski, Adam Gołąb, Andrzej Sikorski

Katedra i Klinika Urologii Pomorskiej Akademii Medycznej w Szczecinie
Kierownik kliniki: prof. dr hab. Andrzej Sikorski

keywords

ureter, ureterolithiasis, laparoscopy, ureteolithotomy

summary

aim

Presentation of local experience in laparoscopic ureterolithotomy (UL) and its place in modern therapy of ureterolithiasis.

methods

UL was performed in 13 patients (4 F, 9 M). Ten patients were primarily planned for laparoscopy with the exclusion of other forms of therapy. Indication for this procedure were the diameter or the length of the deposit >2,5 cm and its prolonged presence in the ureter. Three patients were earlier subjected to unsuccessful ESWL. The age of the patients was from 23 to 70 years (46,9 in average). The concrements were present in 5 patients in the right and in 8 - in the left ureter. Their localization in the lower, medial and upper part of the ureter was 15,4% (2 cases), 69,2% (9) and 15,4% (2), respectively. Retroperitoneal access was used in 11 patients, while transperitoneal - in two patients.

results

The concrements were removed in 12 patients (92%). In one of them the stone displaced during the operation into the kidney where it was crushed by ESWL. Conversion to open operation was not necessary. One patients had to be reoperated after few hours due to haemorrhage into the retroperitoneal space. The average operation time was 73 minutes (30-150 min), postoperative hospitalization period 4.2 (2-11 days).

conclusions

Lack or diminished chance of ESWL and URSL success can be expected in case of big (ł15 mm) concrements, their prolonged presence and localization in the medial part of the ureter; it can be considered the indication for UL. Cosmetic results of this procedure are excellent, the stone can be removed during one session, hospitalization period is short and the patients can regain full activity. The authors prefer the retroperitoneal access as it lowers the risk of urinary leak. UL is an useful alternative for the open method adding the armamentarium of therapy in ureterolithiasis.