Laparoscopic techniques for removal of renal and ureteral calculi.
OBJECTIVE
Although most ureteral and renal stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. The increasing experience with laparoscopy in urology poses the question of whether urolithiasis may be an indication for laparoscopy.


METHODS
A review of the literature was conducted to point out the indications and techniques of laparoscopic stone surgery.


RESULTS
Indications for stone surgery are anatomic abnormalities, such as horseshoe kidneys, malrotated kidneys, or ectopic kidneys; symptomatic stones in diverticula of the renal pelvis; and extremely large stones, especially in children; or concomitant open or laparoscopic surgery. After failure of endourologic stone removal or shockwave lithotripsy, stone surgery may be a second option. In experienced hands, most procedures can be performed laparoscopically, either using a retroperitoneal or a transperitoneal approach. Accurate planning and imaging before surgery is mandatory. Intracorporeal ultrasonography or combined laparoscopic and endourologic techniques may be useful in difficult cases. Functional outcomes and complication rates of the laparoscopic approach are comparable to those of open surgery. The benefits of laparoscopy are lower postoperative morbidity, shorter hospitalization, shorter convalescence time, and better cosmetic results.


CONCLUSIONS
Laparoscopic removal of renal and ureteral calculi plays a role in special cases of urolithiasis. In experienced hands, it can be performed safely and efficiently and may therefore replace open stone surgery in most indications.
Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University , Heilbronn, Germany .
Marcel
M
Hruza
Michael
M
Schulze
Dogu
D
Teber
Ali Serdar
AS
Gözen
Jens Jochen
JJ
Rassweiler
D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D014514:Ureteral Calculi / Q000601:surgery*