Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India.

Garg, Manish; Singh, Vishwajeet; Sinha, Rahul J.; Sankhwar, Satya N.; Kumar, Manoj; Kumar-Dubey, Amit; Prakash, Jai; Kumar, Pradeep; Pandey, Mohit

doi:10.1159/000356254

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Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India.

Author(s): Manish Garg ¹ , Vishwajeet Singh ¹ , Rahul J Sinha ¹ , Satya N Sankhwar ¹ , Manoj Kumar ¹ , Amit Kumar ¹ , Jai Prakash ¹ , Pradeep Kumar ¹ , Mohit Pandey ²

Publication date (Electronic): Nov 2013

Journal: Current urology

Publisher: S. Karger AG

Keywords: Laparoscopy, Ureteral calculus, Ureterolithotomy

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Abstract

Prospective randomized study on transperitoneal laparoscopic ureterolithotomy (TPLU) versus open ureterolithotomy (OU) for treatment of large impacted ureteric stones (≥ 1.5 cm) and assessment of overall results.

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Most cited references 30

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2007 Guideline for the management of ureteral calculi.

Glenn Preminger, Hans-Göran Tiselius, Dean Assimos … (2007)

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Treatment selection and outcomes: ureteral calculi.

Matthew Wolf (2007)

The most important recent advances in the management of ureteral calculi have been the development of medical expulsive therapy to facilitate passage of ureteral stones, such that many calculi that would previously have required procedural treatment now exit the ureter with only pharmacologic treatment; and the improvements in ureteroscopic technology that have enabled retrograde ureteroscopy to become a first-line option for most ureteral stones. Shock wave lithotripsy still plays an important role for many ureteral calculi, particularly smaller ones, and the addition of percutaneous/antegrade ureteroscopy and laparoscopic ureterolithotomy rounds out the treatment options for large or impacted stones. Selection of treatment based upon factors such as size, location, and others will optimize outcome for patients who have ureteral calculi.

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Upper and mid-ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy.

A. K. Hemal, Shakti Goel (2001)

To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the results with those from open surgery. Between March 1994 and mid-December 2000, 55 patients with large (mean 2.1 cm) upper and mid-ureteric calculi, and with normal renal values, underwent RPUL. In 22 patients, earlier attempts with extracorporeal shock wave lithotripsy and ureteroscopy had failed. These patients were compared with 26 (mean stone size 2.4 cm) who underwent open ureterolithotomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location; most stones were calcium-based. The mean operative duration and blood loss for RPUL and open surgery were 108.8 and 98.8 min, and 58.5 and 50.5 mL, respectively (not significant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P<0.001). The duration of convalescence was significantly less after RPUL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which occurred early in the series, and one significant complication amongst patients who underwent RPUL. RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid-ureteric calculi and in those patients where a previous attempt at endourological management has failed. However, the technique requires significant training and experience before good results can be obtained.