Abstract

In a case of upper ureteral stricture refractory to laser ureterotomy, laparoscopic ureteroureterostomy was performed for resection of the stricture and reanastomosis of the ureter. Precise localization of the stricture segment was achieved by retrograde ureteroscopy performed concurrently with laparoscopy, with minimal change in the patients position.

Abstract

This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. The medical data of 50 patients who had undergone retroperitoneal laparoscopic ureterolithotomy between June 2010 and March 2013 were retrospectively analyzed. To assess the learning curve, patients were divided into two groups: Group A (the first 25 cases) and Group B (the last 25 cases). In Group A, double J stents were placed in 17 patients, whereas in Group B 15 patients received double J stents. In Group A, three ports were placed in nine patients and four ports in 16 patients. In Group B, three ports were placed in 20 patients and five patients had four ports. The patients were compared according to demographics, operative time, stone size, complications, hospital stay, and transfusion. The mean age for Group A was 47.8 ± 14.13 (21–72) years and that for Group B was 44.2 ± 14.98 (22–78) years. Mean operative times were 106.4 ± 38 (55–210) minutes and 70.76 ± 30.4 (30–180) minutes for Groups A and B, respectively (p < 0.05). The mean hospital stay was 7.12 ± 4.47 (3–22) days and 4.04 ± 2.05 (2–12) days for Groups A and B, respectively (p < 0.05). The mean stone size was 20.12 ± 5.18 (12–30) mm and 19.44 ± 4.44 (13–28) mm for Groups A and B, respectively (p > 0.05). In our study, as staff experience (in performing laparoscopic retroperitoneal ureterolithotomy) increased, operative time, length of hospital stay, and complication rates have correspondingly declined.