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

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          Abstract

          Aim

          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.

          Material & Methods

          In a prospective study between 2010 to 2012, 30 patients underwent TPLU and 30 OU based on 1:1 randomization. The operation was indicated primarily in 44 cases or after failed shock-wave lithotripsy/ureteroscopy in 16 cases. Two groups were compared for operative time, success rate, visual pain score, analgesic requirement, hospital stay, and postoperative complications. Statistical analysis was performed with SPSS® version 16.0 using Fisher exact or Mann-Whitney U tests with p < 0.05 considered statistically significant.

          Results

          The difference in visual pain score (6.2 in TPLU group vs 3.1 in OU group on day 1; 4.8 vs. 2.4 on day 2) and tramadol requirements (184.32 mg in TPLU group vs. 150.87 mg in OU group on day 1; 97.34 mg vs. 65.56 mg on day 2) were statistically significant and more in OU. Hospital stay and convalescence were significantly lower in the TPLU. However, stone removal in one attempt was similar in both the groups.

          Conclusion

          Although successful stone removal rates are equal in both groups, TPLU is associated significantly with less postoperative pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison to OU.

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          Most cited references30

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          2007 Guideline for the management of ureteral calculi.

          Glenn Preminger, Hans-Göran Tiselius, Dean Assimos … (2007)
          Article 0 comments Cited 90 times – based on 0 reviews     Review now
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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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Curr Urol
                Journal ID (iso-abbrev): Curr Urol
                Journal ID (publisher-id): CUR
                Title: Current Urology
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Print): 1661-7649
                ISSN (Electronic): 1661-7657
                Publication date (Print): November 2013
                Publication date (Electronic): 30 October 2013
                Publication date PMC-release: 30 October 2013
                Volume: 7
                Issue: 2
                Pages: 83-89
                Affiliations
                [1] aDepartment of Urology, King George Medical University, Lucknow, India
                [2] bDepartment of Surgery, Era Medical College, Lucknow, India
                Author notes
                *Manish Garg, Department of Urology, King George Medical University, IN-226003 Lucknow (India), E-Mail dr_manugarg@ 123456yahoo.co.in
                Article
                Publisher ID: cur-0007-0083
                DOI: 10.1159/000356254
                PMC ID: 4017744
                PubMed ID: 24917764
                SO-VID: 4d9c13db-7ccb-4bb5-a335-cc6c9d932e96
                Copyright © Copyright © 2013 by S. Karger AG, Basel
                History
                Date received : 21 April 2013
                Date accepted : 8 August 2013
                Page count
                Tables: 3, References: 34, Pages: 7
                Categories
                Subject: Original Paper

                Keywords: laparoscopy,ureterolithotomy,ureteral calculus
                Data availability:
                Keywords: laparoscopy, ureterolithotomy, ureteral calculus

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