Laparoscopic as a minimally invasive treatment is continuosly gaining place in the treatment of urinary stones,mainly replacing open surgery,it is mostly recommended ror large impacted stones.
To compare the safety, efficacy, operative time, postoperative hospital stay, and complications rate of transperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy for treatment of upper 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 this study. Eighteen patients were treated by transperitoneal laparoscopic ureterolithotomy and 24 patients by ureteroscopy using semi-rigid ureteroscope with Holmium laser lithotripsy. Operative time, intraoperative complications, stone-free rate, postoperative complications, postoperative hospital stay and post-operative auxiliary treatment were compared in both groups.
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 in ureteroscopy group, 46.3 ± 27.3 minutes compared to 66.4± 19.1 minutes in laparoscopic group. Regarding the Patients in laparoscopic group needed longer hospital stay with a mean time of 2.2 ± 0.4 days, while in ureteroscopy group, the meantime of hospitalization was 1.1 ± 0.45 days. The stone free rate in laparoscopic group was 100%, compared to 62.5% in ureteroscopy group giving a statistically significant difference, (P. value = 0.003), and the ancillary treatment was needed in 37.5% of patients treated by ureteroscope. Postoperatively in ureteroscopic group, three patients had gross hematuria, while only one Patients in laparoscopic group had pyelonephritis, however, no significant difference in frequency of post-operative complications between both groups, (P. value> 0.05).
Transperitoneal laparoscopic ureterolithotomy has a higher stone-free rate, but longer operative time and hospital stay compared to ureteroscopic laser lithotripsy for the treatment of upper ureteral stone 15 mm or larger in longest diameter.