Objectives: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. Material and Methods: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. Results: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. Conclusions: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

Keywords:
Endourology, Laparoscopy, Laser, Ureteral Calculus, Ureteroscopy
1.
Sakhaee K, Maalouf NM, Sinnott B: Kidney stones: a global picture of prevalence, incidence, and associated risk factors. J Clin Endocrinol Metab 2012;97:1847-1860.
2.
Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS Jr: EAU/AUA nephrolithiasis guideline panel. 2007 guideline for the management of ureteral calculi. J Urol 2007;178:2418-2434.
3.
Khaladkar S, Modi J, Bhansali M, Dobhada S, Patankar S: Which is the best option to treat large (>1.5cm) midureteric calculi? J Laparoendosc Adv Surg Tech A 2009;19:501-504.
4.
Bapat SS, Pai KV, Purnapatre SS, Yadav PB, Padye AS: Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones. J Endourol 2007;21:1425-1427.
5.
Jeon SS, Hyun JH, Lee KS: A comparison of Holmium: YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation. Int J Urol 2005;12:544-547.
6.
Lopes Neto AC, Korkes F, Silva JL 2nd, Amarante RD, Mattos MH, Tobias-Machado M, Pompeo AC: Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy. J Urol 2012;187:164-168.
7.
Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR, de la Rosette JJ; CROES Ureteroscopy Global Study Group: Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 2014;66:102-109.
8.
Aminsharifi A, Alavi M, Sadeghi G, Shakeri S, Afsar F: Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial. J Endourol 2011;25:927-931.
9.
Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C: EAU Guidelines on Urolithiasis: 5.7 Open and laparoscopic surgery for removal of renal stones. EAU Guideline, 2012, pp 4748.
10.
Binbay M, Tepeler A, Singh A, Akman T, Tekinaslan E, Sarilar O, Baykal M, Muslumanoglu AY: Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones. Int Urol Nephrol 2011;43:989-995.
11.
Wang Y, Hou J, Wen D, OuYang J, Meng J, Zhuang H: Comparative analysis of upper ureteral stones (>15mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy. Int Urol Nephrol 2010;42:897-901.
12.
Seitz C, Tanovic E, Kikic Z, Fajkovic H: Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium:YAG-laser ureterolithotripsy. Eur Urol 2007;52:1751-1757.
13.
Hyams ES, Monga M, Pearle MS, Antonelli JA, Semins MJ, Assimos DG, Lingeman JE, Pais VM Jr, Preminger GM, Lipkin ME, Eisner BH, Shah O, Sur RL, Mufarrij PW, Matlaga BR: A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol 2015;193:165-169.
14.
Pan J, Xue W, Xia L, Zhong H, Zhu Y, Du Z, Chen Q, Huang Y: Ureteroscopic lithotripsy in Trendelenburg position for proximal ureteral calculi: a prospective, randomized, comparative study. Int Urol Nephrol 2014;46:1895-1901.
15.
Zhu H, Ye X, Xiao X, Chen X, Zhang Q, Wang H: Retrograde, antegrade, and laparoscopic approaches to the management of large upper ureteral stones after shockwave lithotripsy failure: a four-year retrospective study. J Endourol 2014;28:100-103.
16.
Fang YQ, Qiu JG, Wang DJ, Zhan HL, Situ J: Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones. Acta Cir Bras 2012;27:266-270.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.