RESUMEN
Objective To evaluate the clinical signifi ca nce of retroperitoneoscopic ureterolithotomy for upper ureteral calculi. Methods Retroperitoneoscopic ureterolithotomy was carried out in 22 p atients with upper ureteral calculi. The operation was performed in the retroper itoneal space. After the upper ureter and calculi were exposed, a scalpel was ut ilized to cut the ureter longitudinally for the removal of calculi. A double-J t ube was inserted into the ureter routinely and the ureterotomy closure was perfo rmed with sutures. Results A conversion to open surgery was needed in 1 patient because the calculi had moved into the kidney. One patient e xperienced urinary leakage at 500～800 ml/d postoperatively, and received an ope n surgery of double-J tube insertion 3 days later. Of the remaining 20 patients, the procedure was successfully accomplished, with the operation time of 50~240 min (mean, 110 min) and the blood loss of 30~100 ml (mean, 50 ml). The time to t he recovery of intestinal functions was 12~30 h (mean, 18 h).The postoperative h ospital stay was 5~8 days (mean, 6.8 days). Follow-up with B-ultrasonography and intravenous urethrography for 1~12 months in the 20 patients found no residual calculi or ureteral stricture. Hydronephrosis disappeared in 15 patients and mil d hydronephrosis was detected in the rest of 5 patients. Conclusions Retroperitoneoscopic ureterolithotomy is a safe and effective option for upper ureteral calculi. It may be considered as the first-line treatment for re latively large-sized upper ureteral calculi.
RESUMEN
Objective To discuss the clinical value of retroperitoneal laparoscopic simple nephrectomy. Methods Retroperitoneal laparoscopic simple nephrectomy was performed in 6 patients, including 5 cases of severe hydronephrosis with non-functioning kidney resulted from ureteral calculi and 1 case of renal tuberculosis. The operation was conducted via retroperitoneal approach. After the upper ureter and the renal pedicle were exposed, the renal artery and vein were clipped and severed. The renal pedicle was occluded only with titanium clips before the removal of the kidney. Results All the operations were performed successfully without complications. The operation time was 130~220 min (mean, 150 min) and the intraoperative blood loss, 80~150 ml (mean, 120 ml). The postoperative hospital stay ranged 5~7 days. Follow-ups for 3 months in the 5 patients with ureterolithiasis revealed normal renal functions. The patient with renal tuberculosis was given anti-tuberculosis therapy and followed for 6 months. No recurrence was seen and the patient’s serum creatinine level was 120 ?mol/L, which was slightly higher than the normal. Conclusions Retroperitoneal laparoscopic simple nephrectomy has advantages of minimal invasion, short hospital stay and rapid recovery. The procedure should be regarded as the “golden standard” for simple nephrectomy.