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To compare the retroperitoneoscopic ureterolithotomy (RPLU) versus open mini-incision ureterolithotomy (MIOU) for large and impacted proximal or mid-ureteric stones in prospective randomized manner and to assess the outcome results. In a prospective randomized study between January 2009 and December 2012, 35 RPLU and 35 MIOU were included in the study. The indications for ureterolithotomy were as primary treatment of large and impacted stones more than 1.5 cm in the proximal and mid-ureter and as salvage treatment of failed ureteroscopy (URS)/extracorporeal shock wave lithotripsy (SWL). The two groups were compared for visual pain score on the first and second postoperative day, analgesic requirement, stone removal in one attempt, operative time, blood loss, postoperative complications, hospital stays and the period of convalescence. The difference in the visual pain score and the tramadol requirement was significantly higher in MIOU group. The hospital stay (RPLU 2.86 ± 0.43, MIOU 5.71 ± 0.67, P <= 0.001) and period of convalescence (RPLU 12.29 ± 4.06, MIOU 24.11 ± 5.55, P <= 0.001) were also significantly higher in MIOU group. The complications were 11.4 % (P <= 0.02) in RPLU versus 17.4 % in MIOU group. However, the stone removal in one attempt was similar in both groups. In condition of failed URS/SWL, unavailability of the full endoscopic armamentarium and limitation of costs, RPLU and MIOU both are safe and effective treatment options for large impacted upper- and mid-ureteric stones and RPLU has better tolerability, lesser hospital time and equal stone clearance rate.[PUBLICATION ABSTRACT]

Background Laparoscopic ureterolithotomy (LU) is an effective option for managing large or impacted ureteral stones when other minimally invasive treatments are not feasible. However, data on outcomes and predictors of recovery after LU remain limited. Methods We retrospectively reviewed 40 patients who underwent LU at a single center. Clinical features, perioperative parameters, and outcomes were analyzed to identify predictors of prolonged hospitalization and postoperative pain. Results All patients achieved stone-free status, and no major intraoperative complications occurred. The mean hospital stay was 4.6 ± 3.5 days. Multivariate analysis showed that postoperative fever ( p  = 0.002), prior percutaneous nephrostomy drainage (PCND) ( p  = 0.009), and longer operative time ( p  = 0.048) independently predicted prolonged hospitalization. Severe postoperative pain was more likely in patients with preoperative acute kidney injury (AKI) ( p  = 0.015) and in those treated with the transperitoneal approach compared with the retroperitoneal approach ( p  = 0.022). Conclusions LU provides excellent stone clearance with minimal complications. Preoperative factors such as PCND and AKI, along with intraoperative choices like surgical approach, influence recovery outcomes. Identifying these predictors may guide perioperative management in LU. Trial registration Not applicable.

Background and Purpose: Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety. Patients and Methods: From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL). Results: The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001). Conclusion: Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery.

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15 mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4 g/dL vs. 1.5 ± 0.7 g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15 mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.

Purpose The aim of this study was to investigate the efficacy and safety of three minimally invasive surgical approaches for treating large upper ureteral stones complicated by infection in elderly (> 60 years) patients. Methods Clinical data from 95 elderly patients with large upper ureteral stones and infection, treated at our hospital between January 2018 and April 2023, were retrospectively analyzed. The surgical approaches included FURL (flexible ureteroscopic lithotripsy) 33 cases, mPCNL (minimally percutaneous nephrolithotomy) 29 cases, and RLUL (retroperitoneal laparoscopic ureterolithotomy) 33 cases. Surgical time, intraoperative blood loss, postoperative hospital stay, reoperation rate, incidence of postoperative complications, and hospitalization costs were observed and compared among the three groups. Results No statistically significant difference was found in stone clearance rates among the three groups ( P  > 0.05). The FURL group exhibited advantages over the mPCNL and RLUL groups in surgical time, intraoperative blood loss, and postoperative hospital stay ( P  < 0.05). However, it also had the highest reoperation rate and hospitalization costs ( P  < 0.05). RLUL demonstrated superiority over the mPCNL and RLUL groups in terms of reoperation rate, incidence of complications, and hospitalization costs ( P  < 0.05). Notably, mPCNL exhibited the highest complication rate at 37.9% ( P  < 0.05). Conclusion For elderly patients with large upper ureteral stones complicated by infection, FURL, mPCNL, and RLUL represent effective surgical approaches. Further attention is needed regarding the perioperative safety of mPCNL. RLUL, which offers higher safety, efficacy, and cost-effectiveness, can be considered a primary surgical option for these patients.

Abstract Objective: This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. Material and methods: A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed. Results: There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Conclusion: Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.

We aimed to compare the safety and efficacy between laparoscopic transperitoneal ureterolithotomy (LTU) and laparoscopic retroperitoneal ureterolithotomy (LRU) in the treatment of large (>10mm) and proximal ureteral stones. Electronic databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus were searched through December 2019. Comparative studies comparing the two approaches were included. The primary outcome was a single-procedure success rate; the secondary outcomes included operative time, hospital duration, and complications (according to the Clavien-Dindo Grade). Newcastle-Ottawa scale (NOS) and the modified Jadad scale were used to evaluate the quality of the included studies. The Egger's test estimated publication bias. The meta-analysis was performed by Review Manager 5.3 and STATA 15.0. Seven studies, involving 125 participants in LTU group and 128 in LRU group, were included in the study. The results suggested that both single-procedure success rate and the rate of postoperative paralytic ileus were significantly higher in the LTU group than in the LRU group (95.2% vs 87.5%, 95% CI: .00-.16, RD = .08, P = .04; 10.4% vs 0, 95% CI: .02- .19, RD = .10, P = .02, respectively). No publication bias of the primary outcome was observed with the Egger's test (P = .117). No significant differences were noted in terms of operative time and hospital duration (95% CI: -18.95-8.80, MD = -5.08, P = .47; 95% CI: -.98- .58, MD = -.20, P = .61, respectively). Additionally, according to Clavien-Dindo Grade, the rates of major complications (>= Grade 3a) including open conversion (.8% vs 5.5%, 95%CI: -.11- .01, RD = -.05, P = .12), stone migration (8.1% vs 6.7%, 95% CI: -.08- .11, RD = .02, P = .76), vascular injury (5.4% vs 0, 95%CI: -.03- .14, RD = .05, P = .21) and ureteral stricture (1.3% vs 5.3%, 95% CI: -.11- .02, RD = -.04, P = .20), were comparable between the two groups. In the treatment of large and proximal ureteral calculi, LTU has a significantly higher single-procedure success rate and a higher rate of postoperative paralytic ileus than LRU. However, the complication was well-tolerated. The small sample size and limited, including studies, were the main limitations.

Introduction: Incidence of pediatric urolithiasis has increased over the last few decades. Procedures such as extracorporeal short wave lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopic lithotripsy are not widely available for pediatric age group in many developing countries. It is desirable that advantages of minimally invasive surgery be offered to selected cases with urolithiasis. Materials and Methods: All patients with pediatric upper tract urolithiasis managed laparoscopically from January 2015 to April 2020 were retrospectively reviewed. Results: A total of 38 patients were included. The mean age of the patients was 8 ± 2.85 years. Thirty-four patients (renal and upper ureteric) were managed through retroperitoneal approach, while those with lower ureteric calculi (n = 4) were approached transperitoneally. A total of eight patients required conversion to open technique. The stone clearance rate was 79% by laparoscopic approach alone. There were no procedure-related complications. Conclusion: Our study suggests that laparoscopic management for pediatric upper tract urolithiasis is a radiation-free, single-time curative treatment and is feasible in centers where facilities for other endoscopic procedures are unavailable.

Aim: To summarize a new and easy technique of double-J stent (DJ stent) placement after retroperitoneal laparoscopic ureterolithotomy (RLU). Materials and Methods: RLU for upper and upper half of mid ureteric stones was performed successfully in 172 patients during the 8-year period between March 2011 and February 2019. In all the cases, a ureteric DJ stent was successfully placed by this new technique. A small-bore antral puncture needle is inserted into the retroperitoneal space to push down a DJ stent with a guidewire into the lower ureter. The tip of the antral puncture needle is manipulated to bring it near the ureterotomy site for easy insertion of the stent. The whole stent is pushed down leaving only the upper end in the ureterotomy area. Then, the guidewire is removed and the upper end is pushed up slowly into the renal pelvis. Results: DJ stents were successfully inserted by this technique in all the 172 cases. In most cases, the stent could be placed in <3 min (range between 2 and 8 min). In two patients, the upper end failed to fully coil in the renal pelvis, but as the stent was passed beyond the ureterotomy site, it served its purpose of an internal drain. None of our cases had any urinary leak. Stents were removed cystoscopically after 6-12 weeks. Conclusion: This technique provides an easy, fast, and safe antegrade method of inserting a DJ stent after RLU.