Comparison of efficacy and safety of open and laparoscopic proximal ureterolithotomy for ureteral stone management: A systematic review and meta-analysis

Ahmad Maliki ^1,2, Rizka Fitriani ^1,2, Mohammad A Soebadi ^1,3

⁰Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Narra J +

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May 27, 2024

View abstract on PubMed

Summary

Open proximal ureterolithotomy is faster, but laparoscopic surgery offers less pain and shorter recovery for ureteral stones. Both surgical methods show comparable bleeding and complication rates.

Area Of Science

Urology
Surgical Oncology
Minimally Invasive Surgery

Background

Proximal ureteral stones often require surgical intervention when non-invasive methods fail.
Open and laparoscopic proximal ureterolithotomy are surgical options for impacted stones.
No systematic reviews have directly compared these two surgical approaches.

Purpose Of The Study

To compare the efficacy and safety of open versus laparoscopic proximal ureterolithotomy.
To evaluate operative time, blood loss, pain, hospital stay, recovery, and complications.

Main Methods

Systematic literature search adhering to PRISMA guidelines across five major databases.
Meta-analysis using random-effects or fixed-effects models to compare outcomes.
Inclusion of two randomized controlled trials and four observational cohort studies (386 participants).

Main Results

Open surgery demonstrated significantly shorter operative times (MD: 26.63 minutes, p<0.0001).
Laparoscopic ureterolithotomy resulted in lower pain scores (MD: -2.53, p<0.00001), shorter hospital stays (MD: -2.40 days, p=0.03), and faster recovery (MD: -9.67 days, p<0.00001).
No significant differences were observed in intraoperative blood loss or overall complication rates between the two approaches.

Conclusions

Open proximal ureterolithotomy offers a time advantage in surgical procedures.
Laparoscopic ureterolithotomy provides superior outcomes in terms of reduced postoperative pain, shorter hospital stays, and quicker recovery.
Both surgical techniques are comparable regarding intraoperative bleeding and complication profiles.

Keywords:

Ureterolith effectiveness laparoscopic open ureterolithotomy proximal ureteral stone