Laparoscopic urinary stone surgery: an updated evidence-based review

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Urinary stone treatment has shifted from open surgery to minimally invasive techniques.
• Endoscopic surgery and shock wave lithotripsy have reduced the need for open stone surgery.
• Laparoscopy is increasingly adopted for urinary stone management.

Purpose of the Study:

• To evaluate the evidence supporting laparoscopic stone extraction.
• To determine the level of evidence and grade of recommendation for laparoscopic urolithiasis treatment using evidence-based medicine criteria.

Main Methods:

• Systematic review of studies on laparoscopic approaches for urinary stone extraction.
• Assessment of evidence levels (e.g., IIa) and recommendation grades (e.g., B) based on established criteria.

Main Results:

• Laparoscopic ureterolithotomy demonstrates the highest level of evidence (IIa) and is recommended (grade B) for impacted or refractory ureteral stones.
• Laparoscopic pyelolithotomy is feasible but rarely indicated (III/B).
• Laparoscopic nephrolithotomy may be considered for specific situations like anterior diverticular stones or failure of other methods (III/B).

Conclusions:

• Laparoscopic ureterolithotomy is a safe and effective minimally invasive alternative to open surgery for specific ureteral stone presentations.
• Laparoscopic approaches for pyelolithotomy and nephrolithotomy have limited indications in the current treatment landscape.