Laparoscopic Ureterolithotomy as a Primary Modality for Large Proximal Ureteral Calculi: Comparison to Rigid Ureteroscopic Pneumatic Lithotripsy
- Authors
- Ko, Young Hwii; Kang, Sung Gu; Park, Jae Young; Bae, Jae Hyun; Kang, Seok Ho; Cho, Dae Yeon; Park, Hong Seok; Cheon, Jun; Lee, Jeong Gu; Kim, Je Jong
- Issue Date
- 1월-2011
- Publisher
- MARY ANN LIEBERT, INC
- Citation
- JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, v.21, no.1, pp.7 - 13
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES
- Volume
- 21
- Number
- 1
- Start Page
- 7
- End Page
- 13
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/113397
- DOI
- 10.1089/lap.2010.0340
- ISSN
- 1092-6429
- Abstract
- Objective: To define the role of laparoscopic ureterolithotomy (LU) as a primary modality for large proximal ureteral stones, we compared the outcomes of primary LU with those of ureterorenoscopy (URS), the currently established modality in this circumstance. Materials and Methods: Among 71 patients who underwent LU in our institution between February 2005 and January 2010, 32 patients with stone size over 1.5 cm who underwent LU as a primary modality without prior shockwave lithotripsy or URS and for whom LU was conducted as a separate procedure were exclusively enrolled. Based on preoperative characteristics of patients and stones, this patient group was matched with the URS group (n - 32, rigid pneumatic lithotripter) during the same period. Results: The LU group and the URS group were similar in age, gender distribution, body mass index, stone size (18.1 +/- 4.2 versus 17.9 +/- 3.6 mm; P = .88), and stone location. Members of the LU group required a longer operative time (118 +/- 53 versus 59 +/- 41 minutes; P < .001) and hospital stay (5.9 +/- 2.1 versus 3.4 +/- 2.4 days; P < .001) and had greater blood loss (155 +/- 62 mL). However, stone clearance rate (no remnant stone in postoperative X-ray of the kidney, ureter, and bladder) in a single session was marginally higher in the LU group (93.8% versus 68.8%; P = .06). Total complication rate was not significant and was slightly higher in the URS group (12.5% versus 21.9%, P = .51). Stone migration into the kidney (n = 2 versus 5), ureteral perforation (n = 0 versus 3), open conversion (n = 1 versus 2), and ureteral stricture (n = 1 versus 2), as long-term complications, occurred more frequently in the URS group. Conclusions: For large proximal ureteral stones, LU can be conducted safely as a first-line procedure without increase of complication rate, compared with conventional URS. Although LU required a prolonged operative time and a longer hospital stay and blood loss was greater, our data showed an advantage of LU in high clearance rate in a single procedure.
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