Laparoscopic Transperitoneal Ureterolithotomy

Shahzad Ali, Muhamamd Mansoor, Saeed Ahmed Khan, Sohail Dilawar

Abstract

Objective

To determine the outcome of trans-peritoneal laparoscopic ureterolithomy in difficult and large ureteric calculi and evulate the safety and efficacy of this procedure.

Study design

Descriptive case series.

Place & Duration of study

Urology Department, Jinnah Postgraduate Medical Center Karachi, from January 2012 to December 2017.

Methodology

Patients with impacted ureteral calculi of more than 15 mm size,  those with the history of failed ESWL or URS were included. Exclusion criteria was patients who had associated COPD and previous abdominal surgeries. The preoperative evaluation included a detailed history, complete blood count, urine culture, renal function profile, coagulation profile and CT-KUB. All procedures were performed through trans-peritoneal route using three port technique in modified lateral position. Antegrade Double J stent was placed where needed. Intraoperative and postoperative complications were noted. Data were analyzed using Statistical Package for the Social Sciences (SPSS, version 20).

Results

Sixty patients were included in the study. The mean age of the patient was 36.65+ 12.41 year (from 15 - 76 year). Right sided calculi were 37 (61.6%) and left sided 23 (38.3%). In 42 (70%) patients calculi were in proximal ureter, 8 (13.3%) in mid ureter and 10 (16.6%) in distal ureter. Calculus size was from 15 mm to 30 mm and the mean calculus size was 18.2+ 2.56 mm. The mean operation time was 99.38+ 22.32 minutes whereas the mean blood loss was 27.35+ 9.9 ml. Stent was placed in 48 (80%) patients while remaining 12 (20%) patients did well without stent. Stone clearance rate was 100%. Overall complication rate was 20%, that included partial ureteric injury, postoperative fever, paralytic ileus and ureteric stricture.

Conclusions

Laparoscopic ureterolithotomy was found safe, minimal invasive and effective modality for treating ureteric calculi as a primary procedure or salvage procedure after failed ESWL and URS.

Key words

Laparoscopy, Ureterolithotomy, Trans peritoneal, Ureteric calculus.