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. 2013 Nov 11:2:600.
doi: 10.1186/2193-1801-2-600. eCollection 2013.

Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function

Takahiro Yasui  1 , Atsushi Okada, Shuzo Hamamoto, Kazumi Taguchi, Ryosuke Ando, Kentaro Mizuno, Yasunori Itoh, Keiichi Tozawa, Yutaro Hayashi, Kenjiro Kohri
Affiliations

Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function

Takahiro Yasui et al. Springerplus. .

Abstract

Purpose: The purpose of this study was to evaluate the efficacy of retroperitoneal laparoscopic ureterolithotomy for the management of large proximal ureteric stones and the impact of this treatment on postoperative renal function.

Methods: The data of 12 patients (7 men and 5 women; mean age, 68.5 ± 8.9 years) with large pyeloureteral junction (2 cases) and upper ureteral (10 cases) stones (25.3 ± 7.4 mm) that had undergone retroperitoneal laparoscopic ureterolithotomy were reviewed. Renal function was analyzed by the estimated glomerular filtration rate (eGFR) and renal scintigraphy using 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) before and 3 months after surgery.

Results: The mean operative time was 129.5 ± 21.4 minutes, with a mean blood loss of 64.4 ± 78.2 mL. The mean duration of hospital stay after surgery was 6.4 ± 2.7 days, and the mean duration of stenting was 7.2 ± 1.7 weeks. A stone clearance rate of 100% was achieved, and no patient developed ureteric stricture. 99mTc-MAG3 scintigraphy showed that laparoscopic removal of calculi did not affect renal function, but did improve ureteral occlusion.

Conclusions: Retroperitoneal laparoscopic ureterolithotomy is a safe and effective treatment option for reducing ureteral obstruction in select patients with large proximal ureteric stones.

Keywords: 99mTc-MAG3; Endourology; Laparoscopic surgery; Renal function; Retroperitoneal approach; Ureterolithotomy.

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Figures

Figure 1
Figure 1
Position of trocars during surgery. (a) A 10-mm camera trocar above the anterior superior iliac spine on the mid-axillary line; (b) A 10-mm trocar below the 12th rib on the posterior axillary line; (c) A 5-mm trocar the 12th rib on the anterior axillary line; (d) A 5-mm trocar on the anterior axillary line above the iliac crest. PAL: posterior axillary line.
Figure 2
Figure 2
Retroperitoneal laparoscopic ureterolithotomy. (a) Stone bulge (arrowheads); (b) Stone removal (arrow); (c) Intracorporeal ureterotomy suturing.
Figure 3
Figure 3
Renogram of renal scintigraphy with 99mTc-mercaptoacetyltriglycine. (a) before and (b) 3 months after surgery. The time from peak to 50% activity (T1/2) of this case improved from immeasurable to measurable. Tmax, time until peak activity.
See this image and copyright information in PMC

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