Laparoscopic transperitoneal ureterolithotomy is an effective and safe method for >15 mm impacted ureteral stones in elderly patients: single center 10-year experience

K. Karkin, E. Vuruşkan, G. Gürlen

Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey. kadir_karkin@msn.com

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• Surgery
• Urology

OBJECTIVE: The aim of our study is to investigate the efficacy and safety of laparoscopic ureterolithotomy operation in elderly patients with large and impacted ureteral stones.

PATIENTS AND METHODS: Between January 2011 and July 2021, 66 elderly patients with impacted, > 15 mm upper and middle ureteral stones underwent laparoscopic ureterolithotomy in our center. The data for all patients were evaluated retrospectively.

RESULTS: The mean age of the patients was 65 ± 5.43 years. The mean stone size was 20.2 ± 2.5 mm. The mean operation time was 93.6 ± 13.2 minutes. Among patients, 16 (24.2%) had history of unsuccessful shock wave lithotripsy and 12 (18.1%) patients had history of ureterorenoscopy. Stone-free rate was 95.4% in all patients. Modified Clavien grade 1 complications were seen in 18 patients (27.2%), but no significant perioperative and postoperative complications were observed. Urinary extravasation lasting 5, 7 and 9 days was observed in 5 patients (7.5%) who were treated conservatively. The mean hospital stay was 3.4 ± 1.52 days. The patients were asymptomatic at the 6th week post-op follow-up, and no stones were seen on direct X-ray and abdominal ultrasonography. Intravenous urography and non-contrast tomography (NCCT) taken 3 months later did not show any obstruction or stenosis in the ureter.

CONCLUSIONS: Laparoscopic ureterolithotomy can be considered as the first treatment option for elderly patients with impacted and large ureteral stones, thanks to its high success and acceptable complication rates.

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