Laparoscopic versus open ureterolithotomy - A comparative study

Objective:The aim of this study is to compare the transperitoneal laparosco pic ureterolithotomy versus conventional open surgery in cases of ureteric stones which failed to be treated: endoscopically. Materials and Methods. In this study, the clinical results of 18 transperit oneal laparoscopic ureterolithotomies (TLU) are compared with 18 open urete rolithotomies (OU) for impacted or large stones of the upper and middle por tion of the ureter that were unable to be disintegrated with extracorporeal shock wave lithotripsy (SWL) or endoscopically. In the analysis of the cli nical data are included the operative time and the post-operative morbidity , length of analgesia needed, hospital stay and convalescence period. Results: All our laparoscopic procedures were accomplished successfully. Th e mean operation time was 130 min for TLU and 85 min for OU. Analgesic medi cation requirement per patient was 1 day for TLU and 4 days for OU while th e postoperative hospital stay averaged 3 days for TLU and 8 days for OU and the time of convalescence was 12 days for TLU and 22 days for OU. No patie nt required a blood transfusion and postoperative complications included ur inary leak, subcutaneous hematoma, subcutaneous emphysema in the TLU group and wound cellulitis and urinary tact infections in the OU group. Conclusion: While most patients with ureteric calculi can be rendered stone -free with SWL and endourological procedures, open stone surgery continues to represent a reasonable alternative for a small segment of the urinary st one population. However, our results reveal distinct benefits of TLU when c ompared to OU and thus laparoscopy instead of open surgery should; be prefe rred. Copyright (C) 2001 S. Karger AG, Basel.