W C Lee1, H H Hsieh. 1. Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Abstract
BACKGROUND: Despite the fact that extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open ureterolithotomy, invasive open surgery is still necessary in some cases of obstinate ureteral stones when less invasive methods fail. Since Wickham first performed a retroperitoneoscopic ureterolithotomy in 1979, procedures which are less invasive than open ureterolithotomy have been available in some selected cases. METHODS: In 1997, retroperitoneoscopic ureterolithotomy was performed in 5 patients with ureteral stones, in whom treatment with other minimally invasive procedures had failed. Using Gaur's technique of balloon dissection of the retroperitoneal space, retroperitoneoscopic ureterolithotomy was successfully performed in all cases. RESULTS: All the patients were treated successfully with the retroperitoneoscopic maneuver. The average operating time was 125 (90 to 175) minutes, and the average blood loss was 75 (20 to 200) ml. No patient required an analgesic injection postoperatively. The average postoperative hospital stay was 5.5 (4 to 8) days, and there were no immediate operative complications in any case. Patients were followed an average of 18.5 (13 to 24) months. A ureteral stricture developed in one patient and was resolved by ureteroureterostomy 3 months after the first operation. CONCLUSION: As an impacted ureteral stone is always associated with chronic ureteritis, firmness and adhesion of the periureteral tissue make the retroperitoneoscopic procedure difficult. In one case, a late complication of ureteral stricture may have been due to pre-existing severe chronic inflammation. Based on our limited experience, retroperitoneoscopic ureterolithotomy provides a practical alternative for the management of ureteral stones in selected patients. An expert clinician with experience in this procedure will provide the best results.
BACKGROUND: Despite the fact that extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open ureterolithotomy, invasive open surgery is still necessary in some cases of obstinate ureteral stones when less invasive methods fail. Since Wickham first performed a retroperitoneoscopic ureterolithotomy in 1979, procedures which are less invasive than open ureterolithotomy have been available in some selected cases. METHODS: In 1997, retroperitoneoscopic ureterolithotomy was performed in 5 patients with ureteral stones, in whom treatment with other minimally invasive procedures had failed. Using Gaur's technique of balloon dissection of the retroperitoneal space, retroperitoneoscopic ureterolithotomy was successfully performed in all cases. RESULTS: All the patients were treated successfully with the retroperitoneoscopic maneuver. The average operating time was 125 (90 to 175) minutes, and the average blood loss was 75 (20 to 200) ml. No patient required an analgesic injection postoperatively. The average postoperative hospital stay was 5.5 (4 to 8) days, and there were no immediate operative complications in any case. Patients were followed an average of 18.5 (13 to 24) months. A ureteral stricture developed in one patient and was resolved by ureteroureterostomy 3 months after the first operation. CONCLUSION: As an impacted ureteral stone is always associated with chronic ureteritis, firmness and adhesion of the periureteral tissue make the retroperitoneoscopic procedure difficult. In one case, a late complication of ureteral stricture may have been due to pre-existing severe chronic inflammation. Based on our limited experience, retroperitoneoscopic ureterolithotomy provides a practical alternative for the management of ureteral stones in selected patients. An expert clinician with experience in this procedure will provide the best results.