Retroperitoneoscopic ureterolithotomy was successfully performed in two pat
ients with impacted upper ureteral stone. The retroperitoneal space was ext
ended using a balloon dissector and four ports were established into the re
troperitoneal space according to Gaur's procedure (1993). The impacted uret
eral stone was removed after the ureter was incised using a hook electrode.
An indwelling splint or stent was placed in the ureter. The incised ureter
was not sutured and an indwelling drain was placed in the retroperitoneal
space. Urine leakage ceased within 3 days postoperatively. With regard to c
omplications. the first patient developed wound infection caused by methici
llin-resistant Staphylococcus aureus and the second patient had abscess for
mation in the psoas muscle. Retroperitoneoscopic ureterolithotomy should be
useful as an alternative treatment for impacted ureteral stones because it
involves minimal postoperative pain.