Laparoscopic ureterolithotomy for upper ureteric calculi.

Laparoscopic ureterolithotomy was performed on 10 patients with upper ureteric stones indicated for open ureterolithotomy after failed prior minimally invasive approaches. Stone size ranged from 7 to 15 mm. (mean 9.3). The routes of approach were all done transperitoneally except in one case in which the retroperitoneal route was initially attempted and later converted to transperitoneal route due to contracted space and unclear landmarks. Stones were all removed successfully with the operating time ranging from 120 to 270 min. (mean 181.5). The only significant complication encountered was urine leak interval postoperatively which were long in 4 patients in whom ureterotomy was not sutured. The longest urine leak interval was seen in a patient whose ureterotomy was neither sutured nor stented. Postoperative pain was rewarding in that seven patients required a single dose of 50 mg of pethidine, two required only oral paracetamol and one required no analgesic at all. Postoperative hospital stay ranged from 5 to 23 days which was actually overwhelmed by urine leak complication. Recovery period was satisfactory which ranged from 10 to 28 days (mean 18.1). Overall laparoscopic ureterolithotomy offers an alternative procedure to open ureterolithotomy with the advantages of minimal postoperative pain and short recovery period.