Retroperitoneal laparoscopic ureterolithotomy for upper ureter stones
Byong Chang Jeong1, Hyeung Keun Park, Seok Soo Byeon
1Department of Urology, Seoul National University Boramae Hospital, Korea.
Journal of Korean Medical Science
|June 17, 2006
Summary
Retroperitoneal laparoscopic ureterolithotomy (RPLU) is challenging for upper ureter stones, especially after failed treatments. However, RPLU can be a viable primary option before open surgery.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Upper ureter stones pose treatment challenges.
- Previous interventions like shock wave lithotripsy (SWL) and ureteroscopy (URS) may fail.
- Laparoscopic approaches offer potential for stone removal.
Purpose of the Study:
- To evaluate the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU) for upper ureter stones.
- To assess RPLU's role as a primary treatment versus salvage therapy.
- To identify factors influencing RPLU success and conversion rates.
Main Methods:
- Retrospective review of 12 patients undergoing RPLU for upper ureter stones (Feb 1998 - Jul 2004).
- Patients included those with large impacted stones and those with prior failed SWL/URS.
- Data collected on operative time, blood loss, hospital stay, and conversion to open surgery.
Main Results:
- 6 out of 12 cases required conversion to open surgery due to adhesions or vascular injury.
- Successful RPLU cases had a mean operative time of 109 minutes and mean blood loss of 50 mL.
- The mean postoperative hospital stay was 4.6 days, with one instance of delayed urinary leakage.
Conclusions:
- RPLU is technically demanding, often indicated for complex cases with adhesions or failed prior treatments.
- Despite challenges, RPLU can be considered as a primary surgical option before resorting to open ureterolithotomy.
- Careful patient selection and surgical expertise are crucial for successful RPLU outcomes.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
01:30Urinary Tract Calculi III: Medical Management
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
01:28Urinary Tract Calculi V: Nursing Management
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
01:28Urinary Tract Calculi I: Introduction
Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...