Laparoscopic ureterolithotomy: the method of choice in selected cases

To evaluate retrospectively the results and complication, efficacy, and safety rates of laparoscopic ureterolithotomy in the treatment of large, impacted ureteric stones.

Between September 1994 and December 2003, 73 patients underwent 75 laparoscopic ureterolithotomies (LUL). Mid- and upper-ureteric stones were removed retroperitoneally in 69 cases (92%). Lower ureteric stones were removed transperitoneally in 6 cases (8%). There were 2 (3%) bilateral LULs in one session, 7 (10%) ipsilateral percutaneous nephrolithotomy, and 6 (8%) ipsilateral ureteroscopy in the same session. The mean age of the patients was 39 years (range, 15-70 years). Mean stone size was 25 mm (range, 12-55 mm).

The success rate was 98.7%, with 1 patient (1.3%) requiring conversion to an open procedure. There were no major complications. Mean operative time was 45 minutes (range, 15-100 minutes). Postoperative analgesic medication was required for 1 day in 39 patients (52%). The postoperative hospital stay ranged from 2 to 5 days (mean, 3 days).

On the basis of our experience, laparoscopic ureterolithotomy is a safe and effective method for the treatment of large, dense, and impacted ureteric stones. In selected cases it can be the first choice of treatment.