Laparoscopic and retroperitoneoscopic surgical treatment of ureteral stones: literature review and the first results

Background / objective Kidney and ureteral stone disease is still actual. Its etiopathogenesis is not well known. The history of nephrolithiasis treatment reaches back to early ages. Open stone removal operations are very rare at present, minimal invasive endoscopic and now laparoscopic operations being preferred. Methods During a year, 10 laparoscopic or retroperitoneoscopic ureteral stone removal operations have been performed at the Vilnius city university hospital. During the operations retroperitoneal cavity has been performed, the removed stones were 1 cm or more in size, blocking the ureter for no less than 1 month. In all cases a ureteral stent has been inserted and the ureter sutured, with draining the cavity near the suture. Results Patients: 6 male and 4 female aged 22 to 81 years. Stones were removed from the upper third of the ureter in 8 cases and from the middle part in 2 cases. Stone size was from 1 cm to 2 cm, the time of obstruction from 4 to 60 weeks. In all cases ESWL had been performed before the operation. In 9 of 10 cases the operation was successful; only one case was converted into an open operation because of bleeding. Operation mean time was 2 h 05 min. Conclusions The first cases showed that laparoscopic operation is a safe, minimal traumatic method of ureteral stone removal. In the first cases there were technical problems, lack of experience, complications, but the last operations allow to expect that this method will become the first choice in the treatment of large, old blocking ureteral stones in the future