LAPAROSCOPIC URETEROLITHOTOMY - THE RESULTS OF AN INITIAL SERIES, ANDAN EVALUATION OF ITS ROLE IN THE MANAGEMENT OF URETERAL CALCULI

Objective To evaluate the place of laparoscopic ureterolithotomy in th e management of ureteric calculi for which extracorporeal shockwave li thotripsy (ESWL) and endourological techniques are unsuitable. Patient s and methods Laparoscopic ureterolithotomy was attempted in nine pati ents (eight men, one woman) with an age range of 26-81 years (mean 55. 5) who had large, long standing and impacted calculi in the upper and mid ureter. The stone size ranged from 5 to 28 mm (mean 13.2) and ston e duration ranged from one to 24 months (mean 8.2). The transperitonea l route was used in six patients and the extraperitoneal route in thre e but was converted to a transperitoneal approach in two. Results The stone was successfully removed in all nine patients. The operative tim e ranged from 80 to 260 minutes (mean 158). No intra-operative complic ation was encountered and no patient required a blood transfusion. Pos t-operative complications included urinary leak and fever. The post-op erative stay ranged from 2 to 13 days (mean 5.2). Conclusions Laparosc opic ureterolithotomy has definite advantages over open ureterolithoto my. Furthermore, the more difficult a stone is for treatment by ESWL a nd endourological techniques, the more suitable it is for laparoscopic removal. For large, hard, longstanding and impacted ureteric calculi, one laparoscopic ureterolithotomy as initial therapy may be preferabl e to multiple endourological and ESWL procedures.