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Objective:To explore the effects of retroperitoneal laparoscopic ureterolithotomy (RLU) and urethral ureteroscopic lithotripsy (URL) on renal function, oxidative stress, and immunoglobulin levels in patients with upper ureteral calculi.Methods:The clinical data of 78 patients with upper ureteral calculi, who received treatment in Yiwu Central Hospital from June 2017 to April 2020, were collected for this study. The patients were divided into URL group ( n = 38, URL treatment) and RLU group ( n = 40, RLU treatment) according to different surgical methods. Renal function (creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin), oxidative stress (superoxide dismutase, malondialdehyde), immunoglobulin (Ig) (IgA, IgM, IgG), and complications were compared between the two groups. Results:At 1 day after surgery, creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin in the RLU group were (79.59 ± 6.02) μmol/L,(6.93±1.17) mmol/L,(4.78±0.61) μg/L, respectively, which were significantly lower than those in the URL group [(86.98 ± 8.27) μmol/L, (7.62 ± 1.24) mmol/L, (6.03 ± 0.79) μg/L, t = 4.53, 2.53, 7.85, P < 0.001, P = 0.014, P < 0.001). At 1 day after surgery, IgA, IgM, and IgG in the RLU group were (1.94 ± 0.25) g/L, (1.55 ± 0.24) g/L, (6.59 ± 1.25) g/L, respectively, which were significantly lower than those in the URL group [(2.38 ± 0.23) g/L, (1.82 ± 0.27) g/L, (7.89 ± 1.36) g/L, t = 8.08, 4.67, 4.40, P < 0.001, 0.001, 0.001]. At 1 day after surgery, malondialdehyde level was significantly lower in the RLU group than in the URL group [(7.49 ± 1.26) mmol/L vs. (8.93 ± 1.38) mmol/L, t = 4.817, P < 0.001]. At 1 day after surgery, superoxide dismutase level was significantly higher in the RLU group than in the URL group [(72.18 ± 7.55) mg/L vs. (63.49 ± 6.69) mg/L, t = 5.37, P < 0.001). There was no significant difference in the incidence of postoperative complications [15.79% (6/38) vs. 7.50% (3/40), χ2 = 1.31, P = 0.252]. Conclusion:RLU for the treatment of upper ureteral calculi has fewer effects on renal function, oxidative stress, and immunoglobulin level in patients with upper ureteral calculi compared with URL and does not increase the incidence of complications.
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INTRODUCTION@#Retroperitoneal laparoscopic (RPL) urologic surgery offers comparable surgical and functional outcomes to the traditional transperitoneal approach, with the advantage of circumventing the need to enter the intraabdominal space. This precludes the necessity to encounter small intestinal and colonic segments, encounter abdominal adhesions, and mobilize adjacent organs, translating to better peri-operative and post-operative conditions. However, RPL demands a strong knowledge of the retroperitoneal anatomy coupled with a level of laparoscopic dexterity, this results in a steep learning curve. Unfortunately, the evidence on the learning curve for RPL is diverse and scarce. The aim of this systematic review was to consolidate the available literature and determine the minimum required number of cases to efficiently and safely perform RPL.@*METHODS@#This is a systematic review of the literature via PubMed, EBSCO and Science Direct of all studies published since 2000 to 2019. The search was conducted by combining the following terms, “Retroperitoneoscopy”, “Retroperitoneoscopic”, “posterior laparoscopy”, “Learning”, “Nephrectomy”, “Adrenalectomy”, and “Ureterolithotomy”. Outcomes of interest were learning curve, mean operative time, mean intra-operative blood loss and mean hospital stay.@*RESULTS@#After the screening phase and application of the eligibility and exclusion criteria, the review included a total of 6 studies on the learning curve for RPL. The learning curve for retroperitoneoscopic adrenalectomy was 40 cases and 24 to 42 cases, based on the evidence from Uitert, et al. (2016) and Vrielink, et al. (2017), respectively. For retroperitoneoscopic nephrectomy, the minimum required number of cases is 30 – 70, based on the studies by Pal, et al. (2017), Zhu, et al. (2018) and Tokodai, et al. (2013). Ercil, et al. (2014) demonstrated the learning curve for retroperitoneoscpic ureterolithotomy to be at 30 cases. Review of each literature showed that completion of the learning curves translated to better peri-operative and post-operative conditions (i.e. shorter operative time, lesser intra-operative blood loss, shorter hospital stay). Overall, the evidence in this review suggests that for posterior retroperitoneal laparoscopy, a mean learning curve of 31 to 56 cases is required to safely and efficiently perform the procedure. @*CONCLUSION@#Retroperitoneal laparoscopic surgery is a valid alternative to the traditional transperitoneal approach. It offers comparable anatomic and functional results, albeit better peri-operative and post-operative outcomes. However, its performance requires a strong knowledge and familiarity of working within the retroperitoneum which can be achieved through progressive experience in RPL. The evidence consolidated by this review suggests a learning curve of 31 to 56 cases prior to effectively performing the procedure.
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Giant ureteral calculus is a rare disease. It remains one of the few special situations where classical treatment of ureterolithotomy is done. We present a case of a 33-year-old female who presented with left flank pain radiating to groin. Investigations revealed two giant ureteral stones measuring 8 cm and 2cm. She was submitted to open surgery. There were no postoperative complications and the patient was discharged from hospital after 4 days. An IVU done 6 months after intervention showed adequate drainage of contrast in bilateral kidneys. This technical procedure could be performed by means of laparoscopy and be even less aggressive.
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Objective To evaluate the clinical efficacy and security of retroperitoneal laparoscopic ureterolithotomy(RLUL) for impacted ureteral calculi after radical cystectomy and ileal conduit.Methods 5 patients with unilateral impacted ureteral calculi after radical cystectomy and ileal conduit received RLUL were selected,and a retrospective study was performed for manner,duration of surgery,complications and length of stay and other indicators,and the treatment effect was evaluated.Results All procedures were successful and the mean operation time was (82.0±27.7)min,the extubation time was (5.4±1.1)d,hospitalization time was (10.0±2.9)d.Postoperative follow up for 6-48 months,there were no obvious complications.Conclusion The RLUL showed satisfactory availability and security for management ureteral calculi after radical cystectomy and ileal conduit.
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Resumen: Introducción: el desarrollo de técnicas de mínimo acceso en el tratamiento de litiasis urinaria ha modificado el manejo de esta patología en la actualidad; sin embargo, el desafío terapéutico continúa siendo grande en pacientes con cálculos complejos del uréter proximal y pelvis renal, donde una buena opción es la cirugía laparoscópica. Materiales y métodos: fueron tratados mediante cirugía laparoscópica 10 pacientes durante el primer semestre del año 2016, portadores de litiasis piélica compleja y de uréter proximal (> 15 mm); edad: 38 años (±11.66). Localización de los cálculos: 8 en el uréter proximal y 2 en la pelvis renal. Resultados: tiempo operatorio: 65 a 270 minutos; pérdida de sangre media: 31.25 ml (± 6.29), producción del dren en el primer día: 36 a 45 ml. Dolor postoperatorio en el primer día postquirúrgico: 3.5 (EVA) (± 2.22). El resultado cosmético fue muy satisfactorio para todos (media: 9.5 ± 0.05). Tasa libre de litiasis: 100%. Discusión: el manejo de los cálculos ubicados en el uréter proximal, cuando son voluminosos o piélicos complejos, son un desafío debido a su menor tasa libre cálculos ya sea con ureterorrenoscopia o litotripcia extracorpórea; una opción para el tratamiento de este tipo de litiasis es la cirugía laparoscópica (tasa libre de cálculos hasta 100% en una sola sesión) y mejoría de los parámetros como estancia hospitalaria, requerimiento de tratamiento analgésico adicional, recuperación y resultados cosméticos. Conclusiones: los cálculos de volumen considerable o situados en una parte del aparato urinario de difícil acceso se tratan con éxito a través del abordaje laparoscópico, que es una opción ideal que sustituye el abordaje abierto y métodos endourológicos en casos seleccionados. Palabras claves: ureterolitotomía laparoscópica, cálculo ureteral, cálculo piélico, ureterorrenoscopia, litotripcia extracorpórea
Introduction: The development of minimal access techniques in the treatment of urolithiasis has changed the management of this condition today; however the therapeutic challenge remains in patients with complex stones in proximal ureter and renal pelvis in which laparoscopic surgery is a good option. Materials and Methods: 10 patients were treated during the first half of 2016, whith diagnosis of complex pelvic lithiasis and proximal ureteral stones (> 15 mm); laparoscopic surgery was indicated. The mean age was 38 years (± 11.66). The location of these lithiasis was 8 proximal ureter and 2 in the renal pelvis. Results: Operative time ranged from 65 minutes to 270 minutes; the mean blood loss was 31.25 cc (± 6.29), drain production on the first day was between 36 ml - 45 ml. Postoperative pain on the first day after surgery was 3.5 (VAS) (± 2.22). The cosmetic result was very satisfactory for all, with an average of 9.5 (± 0.05). stone-free rate was 100%. Discussion: The management of bulky proximal ureteral stones or complex pyelic stones are a challenge because of its low stone-free rate either with ureterorenoscopy or external shock wave lithotripsy; an option for treating this type of stones is laparoscopic surgery, with a stone-free rate up to 100% in a single session and improving parameters such as hospital stay, requirement for additional analgesic treatment, early recovery, and cosmetic results. Conclusions: In complex situations ureteral or pyelic stones are successfully treated through laparoscopic approach, being an ideal choice to replace the open approach and endoruologic methods in selected cases. Key words: laparoscopic ureterolithotomy, ureteral stones, pyelic stones, ureterorenoscopy, shock wave lithotripsy.
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Humans , Nephrolithiasis , Lithotripsy , UrolithiasisABSTRACT
Objective To evaluate the effect of the percutaneous nephrolithotomy ( PCNL) in the manage-ment of complicated upper ureteric calculi , compared with retroperitoneal laparoscopic ureterolithotomy ( RLU ) . Methods Seventy-one cases with complicated upper ureteric calculi were retrospectively investigated ( PCNL group 23 cases,RLU group 29 cases).Clinical data including operation time ,stone free rate and the surgical complications were statistically analyzed .Results All the operations were successful in all 52 cases.Compared with the RLU group,the PCNL group had a significant shorter operation time [(45.12 ±11.56)min vs (82.03 ±12.45)min,t=10.13,P<0.01],and significant difference were detected .A week after the operation,the PCNL group showed a stone free rate of 95.6%(22/23) while the RLU group 100.0%(29/29),and no significant difference were detec-ted.No significant complications ,such as intraoperative or postoperative bleeding and damage to surrounding organs , were detected.The patients were followed up for 6 to 12 months(mean,9 months),and no recurrent stones or ureteral stricture were developed during the period .Conclusion Both PCNL and RLU are safe and effective for complicated upper ureteral calculi.The appropriate method depends on the patients′specific conditions,the unit equipments and the experience of operator .
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Objective To compare the effects of ureteroscopic lithotripsy (URL), minimally invasive percutaneous nephrolithotomy ( MPCNL) , retroperitoneal laparoscopic ureterolithotomy ( RLU) and open ureterolithotomy (UL) for the treatment of complex upper ureteral calculi. Methods The data of 281 patients with complex upper ureteral calculi from January 2005 to January 2013 were retrospectively reviewed. 48 patients of them received treatment of URL, 113 patients received MPCNL, 67 patients received RLU and other 53 patients received UL. Results Success rates of treatment at the first time were:URL 62.5% (30/48), MPCNL 92.9%(105/113),RLU 100%(67/67) and UL 100%(53/53) . The mean blood losses during the operation were:URL (9.2 ± 1.4) mL,MPCNL (72.5 ± 5.8) mL,RLU (43.1 ± 8.5) mL and UL (100.5 ± 9.2) mL. The average operation time of URL group was shorter than three other groups, and the difference was statistically significant (P0.05) . Conclusion Clinical characteristics of patients and individual require ment should be considered comprehensively before an individual treatment choice is made for the treatment of complex upper ureteral calculi.
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INTRODUCCIÓN: La ureterolitectomía endoscópica (URS) es una técnica validada para el manejo de cálculos ureterales, ya que tiene alto poder resolutivo y es poco invasiva. El desarrollo de instrumentos flexibles ha facilitado el manejo endoscópico de los cálculos en uréter medio y proximal. El objetivo de este trabajo es describir la experiencia de nuestro centro en URS. Material y metodos: Análisis retrospectivo de las URS realizadas en nuestro centro entre Diciembre 2009 y Mayo 2012. Se consignaron las características del cálculo, el método de fragmentación, la efectividad del procedimiento y las complicaciones. Se utilizaron los ureteroscopios semirrígido Wolf (6,0-9,5 Fr) y flexible Karl Storz Flex X2. Resultados: Se revisaron 102 ureteroscopías, 85 con ureteroscopio semirrígido y 17 con flexible. Los cálculos tuvieron un promedio de 5,7 mm y 642 UH. El 89,4 por ciento de los cálculos resueltos mediante URS semirrígida se localizaban en uréter distal y 52,9 por ciento de los resueltos con URS flexible en uréter proximal. Se realizó litotripsia con láser Holmium en un 25,9 por ciento y 70,6 por ciento de los casos con URS semirrígida y flexible, respectivamente. Se utilizó litotripsia pneumática en un 4,7 por ciento de los casos de URS semirrígida. En URS semirrígida y flexible, la tasa de stone-free + fragmentos < 2 mm fue de 89,4 por ciento y 88,2 por ciento, respectivamente. Sólo hubo una complicación en nuestra serie (infección urinaria febril en 1 caso con URS flexible). La mediana de hospitalización fue de 1 día (rango 1-5 días). Conclusion: Nuestros resultados reafirman a la URS como una técnica eficaz, segura y poco invasiva para el tratamiento de los cálculos ureterales.
INTRODUCTION: The endoscopic ureterolithotomy (URS) is a validated technique for the management of ureteral calculi, which is highly resolutive and minimally invasive. The development of flexible instruments has facilitated the endoscopic management of stones in the mid and proximal segments of the ureter. The aim of this paper is to describe the experience of our center in endoscopic ureterolithotomy. Material and methods: Retrospective analysis of URS performed at our center between December 2009 and May 2012. We recorded the characteristics of the stones, the fragmentation method, the effectiveness of the procedure and complications. The Wolf semi-rigid (6.0 to 9.5 Fr) and the flexible Karl Storz Flex X2 ureteroscopes were used. RESULTS: We reviewed 102 URS, 85 with semi-rigid and 17 with flexible ureteroscope. The calculi were 5.7 mm and 642 HU in average. 89.4 percent of the stones treated with a semi-rigid URS were localized in the distal ureter and 52.9 percent of the calculi treated with a flexible URS were in the proximal ureter. Holmium laser lithotripsy was performed in 25.9 percent and 70.6 percent of the cases of semi-rigid and flexible URS, respectively. Pneumatic lithotripsy was used in 4.7 percent of the semi-rigid URS. In semi-rigid and flexible URS, the rate of stone-free + fragments < 2 mm was 89.4 percent and 88.2 percent, respectively. There was only one complication in our series (febrile urinary tract infection in 1 case of flexible URS). The median length of stay was 1 day (range 1-5 days). CONCLUSION: Our results confirm that URS is an effective, safe and minimally invasive treatment for ureteral calculi.
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Humans , Male , Female , Adult , Middle Aged , Ureteral Calculi/surgery , Ureteroscopy/methods , Retrospective Studies , Ureterolithiasis/surgeryABSTRACT
ObjectiveTo evaluate the treatment of lower ureteral calculi.Methods Clinical data of 300 cases of lower ureteral calculi were retrospectively analyzed.Among the 300 patients with lower ureteral calculi,171 patients were treated with extracorporeal shock wave lithotripsy (ESWL),95 patients were treated with ureteroscopic lithotripsy (URL),34 patients were treated with laparoscopic ureterolithotomy.ResultsThe clearances of the calculus was 91.81％ with the treatment of ESWL,86.32％ with the treatment of URL and 100％ with the treatment of laparoscopic ureterolithotomy after one month of the treatments.ConclusionESWL is the preferred methods for the treatment of lower ureteral stones.But when the stones≥ 1 cm,URL is superior to ESWL in efficacy; Laparoscopic ureterolithotomy is effective for the treatment of lower ureteral stones which combined with ureteral stricture or ureteral polyps,and with serious incarceration,granulation tissue wrapped around the stone.
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Objective: To summarize our initial experience on single-incision laparoscopic ureterolithotomy in 6 patients, and to evaluate the efficacy and safety of this procedure. Methods: From Jun. 2009 to Jul. 2009, single-incision laparoscopic ureterolithotomies were performed in 6 patients who had a ureteral calculus. The clinical data and operative results were summarized retrospectively. Results: All 6 operations were performed successfully, with no conversion to an open procedure; neither an extra trocar for assistance was needed. No intraoperative complications were noticed. The average operative time was (93.5±30.4) min, the average estimated blood loss was (28.5±16.2) ml, and the average postoperative hospital stay was (5.4±1.1) d. Conclusion: Single-incision ureterolithotomy appears to be safe and effective, and has less trauma and better cosmetic outcomes; but it seems to be more difficult for the surgeon to operate.
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Introducción: Desde la introducción de la laparoscopía en la cirugía urológica se han descrito abordajes por vía transperitoneal y lumboscópica para variadas patologías. La extracción laparoscópica extraperitonealde cálculos ureterales impactados o refractarios a litotripsia extracorpórea o endoscópica, es una buena alternativa a la cirugía abierta tradicional, considerando que posee una menor morbilidad peri operatoria. Objetivos: Describir la experiencia inicial de nuestro Servicio en una serie consecutiva de pacientes sometidos a ureterolitotomía lumboscópica extraperitoneal, en cálculos del uréter medio impactados o refractarios a tratamientos de 1ª línea. Pacientes y Método: Nuestra serie prospectiva se constituyó por 14 pacientes consecutivos que fueron intervenidos entre julio de 2006 a junio de 2007. Todos tenían cálculos ureterales medios con tamaño promedio de 14 mm (6-25). Diez pacientes fueron tratados con LEC inicialmente en forma frustra y 4 casos tenían HUN con exclusión o retardo severo de la eliminación. Todos se intervinieron por vía lumboscópica utilizando 3 puertos de acceso realizando una incisión sobre la cresta iliaca en línea axilar posterior con disección del espacio de trabajo en forma digital. No se usó balón dilatador. Para la ureterotomía (8 cálculos derechos y 6 izquierdos) se utilizó un bisturí frío laparoscópico. En los primeros 6 pacientes se colocó inicialmente un catéter pigtail por vía ascendente el que fue ascendido hasta el riñón antes de la ureterorrafia intracorpórea, procedimiento que se abandonó posteriormente al mejorar la técnica de sutura ureteral. Finalmente se colocó un drenaje Hemo-suc exteriorizado por el puerto más inferior. Resultados: Todos los pacientes quedaron libres de cálculos; la duración de la cirugía promedio fue de 110 minutos (45-210). No se reportaron incidentes intra operatorios ni conversiones. La estadía post operatoria promedio fue de 2,4 días (1-4 días)...
Introduction: Since the introduction of urolaparoscopy, transperitoneal and lumboscopic approaches have been developed to treat a wide variety of pathologies. Considering its reduced perioperative morbidity, lumboscopic extraction of impacted ureteral stones isa good alternative to traditional open surgery for cases that have failed endoscopic management. We report our initial experience in a consecutive series of patients that underwent lumboscopic extraction of impacted mid-ureteral stones refractory to endoscopic management Patients and methods: A total of 14 consecutive patients underwent the procedure between July 2006 and June 2007. Al calculi were in the mid ureter with an average size of 14mm (range 6 to 25 mm). Ten patients had previously undergone ESWL and 4 showed renal exclusion in renogram. Calculi were on the right and left ureter in 8 and 6 cases respectively. All patients underwent lumboscopy using 3 access ports. Access was performed placing the first trocar over the iliac crest at the posterior axilar line, digital dissection was performed without the need of a ballon dilator. Uretrotomy was performed with a cold knife. In the first 6 cases a double J stent was ascended prior to ureterotomy, this manoeuvre was abandoned after ureteral suturing was mastered. A Hemo-suc drain was left in all procedures. Results: All patients were stone free. Mean operative time was 110 minutes (range 45 to 210 minutes).There were no intraoperative complications or conversion to open surgery. Average hospital stay was2,4 days (range 1 to 4 days). Only one patient required double J stenting for a persistent urine leak alter postoperative day 4...
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Humans , Male , Female , Adult , Middle Aged , Ureteral Calculi/surgery , Laparoscopy/methods , Urologic Surgical Procedures/methods , Prospective Studies , Minimally Invasive Surgical Procedures , Treatment OutcomeABSTRACT
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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Middle Aged , Male , Humans , Female , Adult , Urologic Surgical Procedures/methods , Ureteral Calculi/therapy , Ureter/pathology , Treatment Outcome , Time Factors , Sex Factors , Retroperitoneal Space/pathology , Peritoneum , Lithotripsy/methods , Laparoscopy/methodsABSTRACT
Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic ureterolithotomy.Methods A total of 34 cases(38 sides) of middle(5 sides) or upper(33 sides) ureteral calculus were treated by retroperitoneal laparoscopic ureterolithotomy.The stones were(0.8 cm?1.0 cm)~(1.5 cm?3.0 cm) in size.Twenty cases had been previously treated by unsuccessful extracorporeal shock wave lithotripsy(ESWL).Results The operation was successfully completed in 33 cases and a conversion to open surgery was required in 1 case because of extensive adhesion and blood oozing.The operating time was 45~190 min(mean,85.5 min),the intraoperative blood loss was 10~50 ml(mean,20.6 ml),and the postoperative hospitalization,3~7 d(mean,4.3 d).Postoperative recovery was uneventful.No complication was observed during a 3~24 months(mean,9.7 months) of follow-up.Conclusions Retroperitoneal laparoscopic ureterolithotomy is micro-invasive,simple to perform,and safe.
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Objective To compare the therapeutic effects of minimally invasive percutaneous nephrolithotomy(MPCNL) and retroperitoneal laparoscopic ureterolithotomy(RLUL) in the management of impacted upper ureteral calculi.Methods A total of 72 patients with unilateral impacted upper ureteral calculi were treated with MPCNL(n=45) or RLUL(n=27).The operation time,clearance rate of the stone,and the incidence of postoperative hyperpyrexia were statistically analyzed.Results All the operations were completed.As compared to the RLUL group,the MPCNL group had a significant shorter operation time [(43?9) minutes vs(69?17) minutes,t=-11.564,P=0.000].On the day after the operation,both the groups showed a stone clearance rate of 100%.No significant difference was detected in the rate of postoperative hyperpyrexia between the two groups [13.3%(6/45) vs 11.1%(3/27),?2=0.000,P=1.000).The patients were followed up for 1 to 24 months(mean,8 months),none of them developed ureteral stricture or recurrent stones during the period.Conclusion Both MPCNL and RLUL are safe,effective,and feasible for impacted upper ureteral calculi.
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Background: Most abdominal surgery can be done by laparoscopic method. For urologic surgery, laparoscopic surgery is used to cut the kidney, prostate, seminal vesicles and get urinary stones, including the ureter stones.\r\n', u'Objectives: Contribute to improving treatment effects ureter stones by lapasoscopy tranperitoneal ureterolithotomy\r\n', u'Subjects and method: Laparoscopic transperitoneal ureterolithotomy was attempted in 90 patients (50 men and 34 women) with an age range of 22 \ufffd?75 years (mean 43.60+ 11.97 years). Learn characteristics of ureteral calculi (X-ray, ultrasound, urinary map vein) and surgical methods.\r\n', u'Results:The results showed that: Most ureterolith at L3 vertebral level (55.6%) and L4 (40.0%). The stone size ranged from 8 to 22mm (mean 13.87+ 3.25mm) and an average width 4 to 12mm (mean 6.96 + 1.82mm). Most cases of ureteral calculi with the situation fluid in the kidney level 2 (76.7%). The stone has impacted in the upper and mid ureter. Two 10-mm and one 5mm trocars were used. Most cases of stage 2 nasal. The mean operative time was 57.22 + 15.51 minutes (30-90 minutes). \r\n', u'Conclusion: The authors conclude that laparoscopic ureterolithotomy by the transperitoneal approach is a safe and reliable minimally invasive procedure. For large, hard, long-standing and impacted ureteric calculi, one laparoscopicureterolithotomy is an initial therapy\r\n', u'
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Ureterostomy , LaparoscopyABSTRACT
To compare the efficacy and morbidity of laparoscopic ureterolithotomy and open ureterolithotomy via the posterior lumbar approach. Meterials and Methods: A retrospective study was performed by reviewing patient records. Ten patients in the laparoscopic ureterolithotomy group were compared with 15 patients in the open ureterolithotomy via lumbotomy incision group. Twelve patients who had flank ureterolithotomy comprised a control group. Details of age, sex, size and site of the stone, haematocrit, blood urea nitrogen, serum creatinine, degree of hydronephrosis of the affected kidney, contralateral renal function, operative time, operative complication, the amount of postoperative analgesics and length of hospital stay were all compared. Statistical analysis was carried out by the Chi- square test, Anova and LSD multiple comparisons. Results: The preoperative status of the three groups were similar. When the ureterolithotomy via lumbotomy group was compared with the control group (flank ureterolithotomy) the results were similar except that ureterolithotomy via lumbotomy required less analgesics postoperatively (mean 50 mg vs 104, p < 0.001). Ureterolithotomy via lumbotomy patients required the same analgesics as laparoscopic ureterolithotomy. However, laparoscopic ureterolithotomy had a longer operating time (mean 181.5 min vs 88, p < 0.001) and longer period of urine leak postoperatively (mean 6.6 days vs 2.4, p < 0.003) when compared with ureterolithotomy via lumbotomy. Conclusion: Ureterolithotomy via lumbotomy offers similar low discomfort postoperatively compared with laparoscopic ureterolithotomy but had a shorter operating time and less complications.
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PURPOSE: Most stones in the urinary tract can be managed by SWL, percutaneous nephrolithotomy and ureteroscopic lithotripsy, however in some patients whose calculi were not managed by these methods, open surgery must be considered. We performed ureterolithotomy using laparoscopy assisted small incision in upper ureter stone and compared their efficacy with conventional ureterolithotomy. MATERIALS AND METHODS: 10 patients whose stones were not fragmented by SWL or who showed intractable pain were managed by laparoscopy assisted small flank incision of 5cm without insufflation of gas(group I). We compared the efficacy of this procedure with 10 patients who underwent conventional ureterolithotomy(group II) in operating time, the number of analgesics required for the management of postoperative pain control, hospital stay, immediate complication and medical expenses. RESULTS: The stones were successfully removed in all patients. The operating times ranged 40 to 150 min(mean 98.5) in group I and 60 to 190 min(mean 83.0) in group II. The mean requirement of analgesics and hospital stay after surgery were 2.4 times and 3.4 days in group I, and 8.4 times and 6.8 days in group II respectively. The mean medical expenses were 803,000 won in group I and 956,000 won in group II. No intra-operative complication was noted in group II, but 1 patient showed urine leakage in group I, which was managed by placement of ureteral catheter. In immediate postoperative complications, 1 patient complained wound pain persisted over 1 month in group I but 6 patients in group II. CONCLUSIONS: Ureterolithotomy using laparoscopy assisted small incision is another modality in the management of upper ureter stone which was not managed by SWL, percutaneous nephrolithotomy and ureteroscopic lithotripsy. Furthermore, this procedure is safe and effective, and offers significant advantages in hospital stay, requirement of analgesics, and medical expense.
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Humans , Analgesics , Calculi , Insufflation , Laparoscopy , Length of Stay , Lithotripsy , Nephrostomy, Percutaneous , Pain, Intractable , Pain, Postoperative , Postoperative Complications , Ureter , Urinary Catheters , Urinary Tract , Wounds and InjuriesABSTRACT
Laparoscopic ureterolithotomy has been attempted in the management of the large, long-standing, impacted ureter stone. However it was not commonly used because of difficulties in technique. So we report 2 cases of laparoscopic ureterolithotomy using the gasless technique. We performed the laparoscopic ureterolithotomy in two patients with ureter stones by transperitoneal approach. We used the laparolift system which was connected by laparofan retractor. The abdominal wall was elevated effectively, and the ureters were exposed with ease. The stone was successfully removed in all two cases. The operative time was 120 and 140 miniutes respectively. There was no intraoperative or postoperative complication including urinary leak in all cases. Postoperative pain was minimal. This gasless technique is convenient and safe because an operator can use the conventional surgical instruments and avoid the complications directly associated with pneumoperitoneum.
Subject(s)
Humans , Abdominal Wall , Operative Time , Pain, Postoperative , Pneumoperitoneum , Postoperative Complications , Surgical Instruments , UreterABSTRACT
We retrospectively reviewed 913 stone treatment cases except the cases of spontaneous passage from March in 1992 to February in 1995. The operations performed for urinary stone consisted of 42 ureterolithotomies, 3 pyelolithotomies, 17 PNLs, 67 URS. The others of 762 cases were treated by extracorporeal shockwave lithotripsy (ESWL). .Forty-five open surgery were performed among 913 stone treatment procedures (4.9%). The indications of open surgery for lower ureteral stone included failed URS with and without prior ESWL and abnormalities limiting endoscopic access. Anatomic factors that required open surgery included duplicating system with ureterocele and duplicating system with ureteral polyp. The indications of open surgery for upper ureteral and ureteropelvic junction stone included failed ESWL, desire for one session success (short treatment time available by patient), poor economics for ESWL, unrelieved intractable pain, bilateral ureteral stone with anuria, suspicious malignancy, stone combined with ureteral stricture below. Open stone surgery has become more complex procedure. Patients undergoing open surgery, were usually combined by anomalies or obstruction requiring surgical correction, suspicious cancer or no definite preoperative diagnosis, need to relieve obstruction as soon as possible, the cases picked up by patient for their preference. We think the open surgery still can offer more benefit to the patient with above listing conditions.