Effects of Laparoscopic Ureterolithotomy and Simultaneous Trans-Trocar Semi-Rigid Ureteroscopy on Stone-Free Rate in the Treatment of Proximal Ureteral Stones

ObjectiveThis study presents the effects of the use of semi-rigid ureteroscopy simultaneously during laparoscopic ureterolithotomy on the stone-free rate and, the techniques used to perform laparoscopic ureterolithotomy less invasively.Materials and MethodsBetween November 2011 and July 2013, laparoscopic ureterolithotomy was performed in 19 patients with proximal ureteral stones. A history of failed shock wave lithotripsy (SWL) or semi-rigid ureteroscopy (sr-URS), presence of ureter stones >= 15 mm and/or impacted stones, or a socioeconomic status not allowing the patient to reach an advanced center for flexible ureteroscopy (f-URS) were identified as the surgical indications.ResultsFourteen male (74%) and five female (26%) patients were enrolled in the study and the mean age was 36.4 +/- 15.11 (15-70) years. The stones were located on right side in five patients (26%) and left side in 14 patients (74%). The mean stone size was 16.2 +/- 3.55 mm (8-22). The mean operation time was 138.9 +/- 29.56 minutes (90-200). The mean urethral catheter and drain removal time was 31.2 +/- 24.28 (16-120) and 50.8 +/- 33.61 hours (18-168), respectively. There was no postoperative complication in long-term period and stone-free rate was 100%.ConclusionLaparoscopic ureterolithotomy is a feasible alternative in a patient who had previously failed minimally invasive methods and/or with large impacted proximal ureteral stone. Furthermore, to use semi-rigid ureteroscopy during the laparoscopic procedure increases the stonefree rate and prevents the need for an additional procedure in case of concurrent presence of small kidney stones.