Laparoscopic ureterolithotomy as a primary modality for large proximal ureteral calculi: Comparison to rigid ureteroscopic pneumatic lithotripsy

Objective: To define the role of laparoscopic ureterolithotomy (LU) as a primary modality for large proximal ureteral stones, we compared the outcomes of primary LU with those of ureterorenoscopy (URS), the currently established modality in this circumstance. Materials and Methods: Among 71 patients who underwent LU in our institution between February 2005 and January 2010, 32 patients with stone size over 1.5 cm who underwent LU as a primary modality without prior shockwave lithotripsy or URS and for whom LU was conducted as a separate procedure were exclusively enrolled. Based on preoperative characteristics of patients and stones, this patient group was matched with the URS group (n = 32, rigid pneumatic lithotripter) during the same period. Results: The LU group and the URS group were similar in age, gender distribution, body mass index, stone size (18.1 ± 4.2 versus 17.9 ± 3.6 mm; P = .88), and stone location. Members of the LU group required a longer operative time (118 ± 53 versus 59 ± 41 minutes; P < .001) and hospital stay (5.9 ± 2.1 versus 3.4 ± 2.4 days; P < .001) and had greater blood loss (155 ± 62 mL). However, stone clearance rate (no remnant stone in postoperative X-ray of the kidney, ureter, and bladder) in a single session was marginally higher in the LU group (93.8% versus 68.8%; P = .06). Total complication rate was not significant and was slightly higher in the URS group (12.5% versus 21.9%, P = .51). Stone migration into the kidney (n = 2 versus 5), ureteral perforation (n = 0 versus 3), open conversion (n = 1 versus 2), and ureteral stricture (n = 1 versus 2), as long-term complications, occurred more frequently in the URS group. Conclusions: For large proximal ureteral stones, LU can be conducted safely as a first-line procedure without increase of complication rate, compared with conventional URS. Although LU required a prolonged operative time and a longer hospital stay and blood loss was greater, our data showed an advantage of LU in high clearance rate in a single procedure.