title: When is open ureterolithotomy indicated for the treatment of ureteral stones?
abstract: OBJECTIVE
  Improvements in extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy have almost eradicated the need for open surgery in ureteral stones. The aim of this study was to assess characteristics of patients who underwent open ureterolithotomy.
  
  
  METHODS
  During a 5-year period, a total of 654 patients with ureteral stones were treated. Initial management consisted of ureteroscopy in 524 patients, ESWL in 62 patients and percutaneous nephrolithotomy (PCNL) in 12 patients. Open surgery was performed in 56 patients. Stone location, size and success rates were retrospectively analyzed.
  
  
  RESULTS
  Ureteroscopy resulted in successful stone removal in 94%, 98% and 98.5% of proximal, mid and distal ureteral stones, respectively. A total of 14 patients with ureteroscopy failure were referred for open surgery. ESWL treatment resulted in success in 55 patients (88%), and those with ESWL failure were referred for either ureteroscopy (n = 3) or open surgery (n = 4). Open surgery was performed in a total of 56 patients, 38 of whom had been referred from other centers. Stone location was proximal ureter in 25 (44.6%) patients (stone size: 2-12 cm(2)), mid ureter in five (8.9%) patients (stone size: 2-6 cm(2)) and distal ureter in 26 (46.4%) patients (stone size: 4-9 cm(2)). A history of previous unsuccessful endourological procedure was observed in 33 (58%) of 56 patients. Children under age 16 (range 1-15 years) comprised 17.8% of patients undergoing open surgery.
  
  
  CONCLUSIONS
  Open surgery, which is nowadays being replaced with laparoscopic techniques, is generally indicated for failed endourological procedures (58%), particularly in centers that do not have flexible ureteroscopy or laser lithotriptor, and in patients with larger stones (>3 cm). Children (17.8%) are also candidates for open surgery, if specifically designed endourological equipment is not available.
authors.affiliation: Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet Yaser
authors.initials: AY
authors.lastname: Muslumanoglu
authors.forename: Mert Ali
authors.initials: MA
authors.lastname: Karadag
authors.forename: Ahmet Hamdi
authors.initials: AH
authors.lastname: Tefekli
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunrende
authors.forename: Adem
authors.initials: A
authors.lastname: Tok
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Berberoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014514:Ureteral Calculi / Q000601:surgery; D053039:Ureterolithiasis / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*