Upper and mid-ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy

Objectives To review our experience of retroperitoneoscopic ureterolithotom y (RPUL) and to compare the results with those from open surgery. Patients and methods Between March 1994 and mid-December 2000, 55 patients with large (mean 2.1 cm) upper and mid-ureteric calculi, and with normal re nal values, underwent RPUL. In 22 patients, earlier attempts with extracorp oreal shock wave lithotripsy and ureteroscopy had failed. These patients we re compared with 26 (mean stone size 2.4 cm) who underwent open ureterolith otomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location: most stones were calcium-based. Results The mean operative duration and blood loss for RPUL and open surger y were 108.8 and 98.8 min. and 58.5 and 50.5 mL, respectively (not signific ant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P < 0.001). The duration of convalescence was significantly less after RP UL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which O ccurred early in the series, and one significant complication amongst patie nts who underwent RPUL. Conclusions RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid-ureteric calculi and in th ose patients where a previous attempt at endourological management has fail ed. However, the technique requires significant training and experience bef ore good results can be obtained.