[Laparoscopy in the management of upper urinary tract stones based on a series of 18 cases].
OBJECTIVE
To evaluate the efficacy and morbidity of laparoscopic surgery in the management of upper urinary tract stones.


METHODS
Between January 1998 and July 2004, 18 patients (14 males, 4 females) underwent laparoscopic extraction of an upper urinary tract stone. Stones were lumbar (n=13), ureteropelvic (n=2), iliac (n=1), inferior caliceal (n=1), and intradiverticular (n=1) with a mean diameter of 15 mm (range: 8-25 mm). Fifteen stones were obstructive. Laparoscopy was performed after failure of one or several previous treatments in 9 cases: ESWL (n=2), retrograde (n=1), anterograde ureteroscopy (n=6). A retroperitoneal approach (n=15) was used for caliceal and lumbar stones and a transperitoneal approach (n=3) was used for pyeloureteric and iliac stones.


RESULTS
The mean operating time was 80 minutes (range: 40-150 min). The mean blood loss was 50 cc (range: 0-250 cc). The mean length of stay was 3.86 days (range: 2 to 7 days). Fifteen patients were drained by a double J stent for one month. The stone was removed by laparoscopy in every case. One patient developed a urinoma requiring surgical repair via a lumbar incision.


CONCLUSIONS
Laparoscopy currently constitutes an attractive alternative for the treatment of upper urinary tract stones and, in this study, was indicated for first-line treatment of obstructive stones larger than 12 mm impacted in the ureter or after failure of previous treatments.
Service d'Urologie, Hôpital Pellegrin, Bordeaux, France. vincentvallee2002@yahoo.fr
Vincent
V
Vallée
Damien
D
Emeriau
David
D
Faramarzi-Roques
Philippe
P
Ballanger
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D014514:Ureteral Calculi / Q000601:surgery*