Retroperitoneoscopic ureterolithotomy – our experience

Objectives. To compare our initial results of retroperitoneoscopic ureterolithotomy (RPUL) with the standard technique of open ureterolithotomy (OL). Material and Methods. Retroperitoneoscopic ureterolithotomy (RPUL) performed in 60 patients (40 men, 20 women). The indications for this operation were large impacted stones (more than 1.5 cm), grown into the mucosal layer of the upper and middle third of the ureter, not amenable to extracorporeal shock wave lithotripsy or endoscopic removal. In all cases, because of the large size, high density and duration of standing stones was originally scheduled to RPUL. Sizes of the stones were from 15 to 32 mm, in 36 cases they were located in the upper third, in 24 cases in the middle third of the ureter. The results were compared with the results of retrospective group of 52 patients who underwent open surgery. Sizes of the stones were similar. We compared the duration of the operation, the frequency of complications, doses of analgesics used and the post-operative hospital stay. RPUL was successful in 58 patients (96.6%). Results. In two cases, the stones were not detected because of moving them to the pelvis. These stones were subsequently crushed by ESWL on the JJ stent. In the postoperative period, 2 patients had urinary leakage, which stopped after the PC nephrostomy (Complication Grade 3B according to modified classification of Clavien-Dindo). In groups of RPUL and open ureterolithotomy were not significant differences in the duration of the operation (RPUL mean 55 min (40-80) vs OL mean 58 min (35-70), the frequency of minor complications (RPUL 21.3% vs OL 19.6%), doses of analgesics were used (RPUL 75 mg vs OL 100 mg) and the post-operative hospital stay (RPUL 3.0 days vs OL 3.5 days). Conclusions. RPUL is an effective, safe treatment for large stones buried in the lining of the ureter and may be an alternative treatment in the hands of urologists owning a laparoscopic surgical technique.

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