Title: Retro-peritoneal Laparoscopic Ureterolithotomy for Proximal Ureteral Stones: An Experience from a Tertiary Care Institute from Kashmir Valley
Authors: Zahid Mohd Rather, Mohd Nazrull Islam, Imran Nazir Mir, Nighat Ara Majid, Raja Waseem Mohd
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.161
Abstract
Background: Currently, shock wave lithotripsy (SWL), ureteroscopy (URS) and HO:YAG laser are the first line of treatments for patients with ureterolithiasis requiring surgical management. At centers which don’t have access to expensive equipment needed in URS and SWL, Laparoscopic ureterolithotomy may be used as a primary procedure. The aim of this study is to share our experience of retroperitoneal laparoscopic ureterolithotomy for proximal ureteric calculi and evaluate the safety and efficacy of this procedure.
Material and Methods: This prospective study was conducted from March 2011 to August 2017 at our centre. A total of 94 patients with proximal ureteric stone who accepted laparoscopic ureterolithotomy were enrolled in the study. The evaluation and assessment of all these patients was done on the OPD basis with reference to their indication and suitability for laparoscopic ureterolithotmy modality of treatment.
Results: The mean age was 37 years. There were 61(64.89%) males. The stones were located in the right side in 58(61.70%) patients. 66(70.21%) patients have upper ureteral stone and 28(29.78%) patients have middle ureteral stones. The average stone size was 14.5 mm. Various complications that occurred during the procedure were difficulty in ureter localization, bleeding, injury to peritoneum, stone migration, and urinary leakage. The mean operative time was 65 minute and the mean blood loss was 70.50 ml. Mean hospital stay was 2.1 days and the stone clearance was 92(97.87%).
Conclusion: Even though SWL and URS are considered to be the first-line treatment for ureteral stones, retroperitoneal laparoscopic ureterolithotomy is a very effective minimally invasive modality of treating ureteral calculi. Unlike URS this procedure can give 100% stone clearance in one session. Although its role as a salvage procedure for failed ESWL, and ureteroscopy is undisputed, in selected patients with large chronically impacted ureteric stones, it may be considered the first line of treatment.
Keywords: Uteric calculus, Retro-peritoneal laparoscpy, ureterolithotomy
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