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World journal of Minimal Access Surgery Volume No 9

Original Article Open Access

Transperitoneal Laparoscopic Management of Ureteric Stones: A Prospective Study

Reyaz Wani and Muneer Para
World journal of Minimal Access Surgery 2020, 8:1

Abstract

Background

Ureteral calculi affect a large section of population and most of them are symptomatic. Depending on the size and location of stone, the treatment can range from observation, pharmacotherapy, endourological intervention, shock wave lithotripsy (SWL), laparoscopic or open retrieval. Though the indications of open and laparoscopic interventions are declining with advances in endourology, these options are still considered in large impacted stones. We share our experience with laparoscopic transperitoneal ureterolithotomy for large and difficult ureteric stones.

Methods

A prospective study over a period of one year was undertaken at a tertiary care government centre in North India. The patients of ureteric calculi were enrolled on both emergency and outpatient basis. After evaluation, a set of patients (Age >> 17 years; Stone size >15mm) were selected for laparoscopic transperitoneal ureterolithotomy. The outcome was recorded in terms of operative time, complications, stone clearance rate and hospital stay.

Results

A total of 30 patients underwent laparoscopic transperitoneal ureterolithtomy. The main complaints were abdominal pain in about 80%, vomiting in 60%, dysuria in 11% and hematuria in 10% patients. The stones ranged in size from 16 mm to 25 mm with average size of 19.5 mm. All patients were operated by single surgeon with a mean operative time of 82.60 minutes. There were no major perioperative complications with a stone clearance rate of 100%. Two patients had minor complications in the form of postoperative fever and paralytic ileus, which were managed conservatively. Most of the patients were discharged on or before 3rd postoperative day.

Conclusions

Laparoscopic transperitoneal ureterolithotomy is a good treatment modality for large stones not feasible for ureteroscopic removal or SWL. Besides the advantages over open surgery, MIS has very high stone clearance rate and minimal complications.

Keywords

Ureteral calculi, ureteroscopy, Shock wave lithotripsy (SWL), intravenous urogram (IVU), stone clearance rate




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