Transperitoneal Laparoscopic Ureterolithotomy and Ureteroscopic Laser Lithotripsy for Treatment of Proximal Ureteral Stones, a Comparative Study


BACKGROUND:Laparoscopic as a minimally invasive treatment is continuosly gaining place in the treatment of urinarystones,mainly replacing open surgery,it is mostly recommended ror large impacted stones.OBJECTIVE:To compare the safety, efficacy, operative time, postoperative hospital stay, and complications rate oftransperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy for treatment ofupper ureteral stones, equal to or larger than 15 mm in longest diameter.PATIENT AND METHODS:Forty-two patients with upper ureteral stones of 15 mm or larger in longest diameter were included in thisstudy. Eighteen patients were treated by transperitoneal laparoscopic ureterolithotomy and 24 patients byureteroscopy using semi-rigid ureteroscope with Holmium laser lithotripsy. Operative time, intraoperativecomplications, stone-free rate, postoperative complications, postoperative hospital stay and post-operativeauxiliary treatment were compared in both groups.RESULTS:The mean stones size was comparable in both groups, it was 20.5 ± 6.8 mm in Ureteroscopy group and 20.3± 6.7 mm in laparoscopic group, (P. value > 0.05). The mean operative time was significantly shorter inureteroscopy group, 46.3 ± 27.3 minutes compared to 66.4± 19.1 minutes in laparoscopic group. Regardingthe Patients in laparoscopic group needed longer hospital stay with a mean time of 2.2 ± 0.4 days, while inureteroscopy group, the meantime of hospitalization was 1.1 ± 0.45 days. The stone free rate inlaparoscopic group was 100%, compared to 62.5% in ureteroscopy group giving a statistically significantdifference, (P. value = 0.003), and the ancillary treatment was needed in 37.5% of patients treated byureteroscope. Postoperatively in ureteroscopic group, three patients had gross hematuria, while only onePatients in laparoscopic group had pyelonephritis, however, no significant difference in frequency of postoperativecomplications between both groups, (P. value> 0.05).CONCLUSION:Transperitoneal laparoscopic ureterolithotomy has a higher stone-free rate, but longer operative time andhospital stay compared to ureteroscopic laser lithotripsy for the treatment of upper ureteral stone 15 mm orlarger in longest diameter.