Laparoscopic Ureterolithotomy for Impacted Ureteric Calculi

Abstract and Introduction

Abstract

Background: The ideal treatment for upper ureteric calculi is still debatable, particularly for patients with large, impacted ureteric calculi. Retroperitoneal laparoscopic ureterolithotomy (RLU) may be a worthwhile alternative to open surgery. In this study, we retrospectively evaluated our clinical experience associated with RLU performed for impacted upper ureteric calculi (>1.5 cm) help urologists in clinical practice and provide a reference for clinical work.

Methods: A total of 64 cases (38 males; 26 females) with impacted upper ureteric calculi between April 2018 and January 2020 were analyzed retrospectively. The basic information of the included research subjects are as follows: The mean age was 50.8±25.4 years. The largest stone diameter was 1.8±0.3 cm. The mean stone retention time was 42±11 days. The mean degree of hydronephrosis was 2.8±1.2 cm.

Results: The mean operative time was 85.4±18.3 minutes. The mean hospital duration was 7.5±1.8 days. The stone-free rate was 98.4%. Two patients required additional intervention. Post-operative fever developed in 3 patients. The decrease in hemoglobin levels was 7.8±3.6 g/L. The increase in procalcitonin (PCT) level was 3.7±1.8 ng/mL. No major complications, for example, sepsis, bleeding, bowel injury, or cardiopulmonary morbidities, were reported.

Conclusions: RLU should be regarded as an excellent first line treatment modality for impacted upper ureteric calculi (>1.5 cm) owing to the high success rate, low complication rate, and the short length of operative time and hospital duration.

Introduction

The ideal treatment for upper ureteric calculi is still being debated, particularly for patients with large, impacted calculi.^[1,2] The conventional treatments include extracorporeal shock wave lithotripsy (ESWL), transurethral ureteroscopy lithotripsy (URL), flexible ureteroscopy (FURS), percutaneous nephrolithotomy (PCNL), retroperitoneal laparoscopic ureterolithotomy (RLU).

ESWL is a common treatment, but it is affected by the limitations of diffusion space, inflammatory polyp and tortuous ureter, which often make the effect of crushing and removing stones unsatisfactory.^[3] ESWL may not be effective because impacted calculi are usually wrapped around or adhere to ureteral polyps. When this happens, URL or FURS are options for treatment, but they can have a lower clearance rate and greater risk of complications.^[3–5] When URL treats the upper ureteral stones, the incidence of the stones moving up to the kidney can be as high as 25–40%.^[6] Another treatment option is PCNL. The advantages of PCNL are simple operation, no need to establish pneumoperitoneum, and avoid pneumoperitoneum related complications. But serious bleeding and infection are unavoidable risks of PCNL.^[7] The main cause of PCNL bleeding is the damage of renal parenchyma and the intraoperative injury. In recent years, the incidence of renal artery embolism in PCNL is 0.80–2.74%.^[8] Serious infection was related to the amount of perfusion fluid and the pressure of perfusion during surgery.^[9] To avoid these complications, the laparoscopic approach may be a worthwhile alternative to open surgery. The laparoscopic approach of RLU was reported by Wickham in 1979. After Gaul described an innovative retroperitoneal laparoscopic balloon dissection technique did laparoscopic urology become established as a minimally invasive therapeutic method. The advantage of RLU is that there is no need to establish renal parenchymal channel and perfusion during stones removal. But RLU can cause stones displacement, postoperative leakage of urine and ureteral stricture. In this paper, we present our experience in avoiding migration of the stones using RLU in the treatment of impacted upper ureteric calculi. We present the following article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-21-1155/rc).