Prospective trial comparing laparoscopy and open surgery for management of impacted ureteral stones.
OBJECTIVE
To investigate two practical approaches in ureterolithotomy for the treatment of large impacted stones, we carried out the assessment and monitoring of perioperative features of consecutive patients undergoing ureterolithotomy after unfavourable results from endourological treatment.


METHODS
Of the 110 patients included in the study, 34 underwent laparoscopic ureterolithotomy. Patients were divided into three ureterolithotomy subgroups: group A, 76 open operations; group B, 16 transperitoneoscopies, and group C, 19 retroperitoneoscopies. All procedures were conducted in a specialised urology programme for resident physicians.


RESULTS
The patients' age, sex, ASA classification and stone characteristics showed no significant differences between the groups. Overall, the complication rate and operation times recorded were similar. One patient had bilateral stones and both sides were treated in a single transperitoneoscopic procedure. Three retroperitoneoscopies ended up in open surgery due to technical difficulties. A prolonged urinary leakage occurred in 3/35 cases (8.5%), and 2 of these patients were treated by insertion of a ureteral catheter. Both laparoscopic groups had significantly lower analgesia requirements and shorter hospitalisation periods (p < 0.001 and p = 0.003, respectively). No patient had stones in the follow-up visit the following month.


CONCLUSIONS
To our knowledge, this is the first prospective comparison of laparoscopic and open ureterolithotomy in a laparoscopic training environment. Although these interventions were conducted by urologists with limited laparoscopic experience, laparoscopy offered significant advantages over traditional open ureterolithotomy, resulting in improved analgesia and shorter hospital stays, but with similar complication rates.
Almeida
Gilberto L
GL
Urology Department, Federal University of Health Sciences of Porto Alegre, Santa Casa Hospital, Porto Alegre, Brazil.
Heldwein
Flavio L
FL
Graziotin
Tulio M
TM
Schmitt
Caio S
CS
Telöken
Cláudio
C
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000150:complications / Q000601:surgery*