Ureterolithotomy Using Laparoscopy Assisted Small Incision in Upper Ureter Stone / 대한비뇨기과학회지

ABSTRACT

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.