Prospective trial comparing laparoscopy and open surgery for management of impacted ureteral stones

Abstract

Introduction and objectives: To investigate two practical approaches in ureterolithotomy for the treatment of large impacted stones, we carried out the assessment and monitoring of perioperative features of consecutive patients undergoing ureterolithotomy after unfavourable results from endourological treatment.

Methods: Of the 110 patients included in the study, 34 underwent laparoscopic ureterolithotomy. Patients were divided into three ureterolithotomy subgroups: group A, 76 open operations; group B, 16 transperitoneoscopies, and group C, 19 retroperitoneoscopies. All procedures were conducted in a specialised urology programme for resident physicians.

Results: The patients' age, sex, ASA classification and stone characteristics showed no significant differences between the groups. Overall, the complication rate and operation times recorded were similar. One patient had bilateral stones and both sides were treated in a single transperitoneoscopic procedure. Three retroperitoneoscopies ended up in open surgery due to technical difficulties. A prolonged urinary leakage occurred in 3/35 cases (8.5%), and 2 of these patients were treated by insertion of a ureteral catheter. Both laparoscopic groups had significantly lower analgesia requirements and shorter hospitalisation periods (p < 0.001 and p = 0.003, respectively). No patient had stones in the follow-up visit the following month.

Conclusions: To our knowledge, this is the first prospective comparison of laparoscopic and open ureterolithotomy in a laparoscopic training environment. Although these interventions were conducted by urologists with limited laparoscopic experience, laparoscopy offered significant advantages over traditional open ureterolithotomy, resulting in improved analgesia and shorter hospital stays, but with similar complication rates.