Laparoscopic ureterolithotomy: an experience of 15 cases

ABSTRACT

To review our experience of laparoscopic ureterolithotomy and revisit its indications in the current era of minimally invasive urologic surgery. A descriptive study. The study was conducted at the department of Urology, Foundation University Medical College and Fauji Foundation Hospital, Rawalpindi from January 2007 to December 2009. We performed laparoscopic ureterolithotomies on fifteen patients for large [1.5-2.5 cm], impacted upper and middle ureteric calculi. In 10 patients laparoscopic ureterolithotomy was adopted as a primary procedure, four patients had stones resistant to Extracorporeal Shockwave Lithotripsy [ESWL], while one patient had failed ureterorenoscopy [URS]. An extraperitoneal approach was selected in all the patients. There were 11 patients with upper ureteric calculi and four with midureteric calculi, the procedure was successful in 14 cases. One patient required conversion to open ureterolithotomy. The average operating time was 50 minutes. The average hospital stay was 2.5 days. There was no major complication. One patient had persistent drain for four days. IVU at three months follow-up was normal in all cases. Laparoscopic ureterolithotomy in selected cases is a good minimally invasive procedure. Large, impacted, hard calculi which are resistant to ESWL and difficult to fragment endoscopically without flexible ureteroscopes and holmium laser can be managed by this technique