Open surgery, laparoscopic surgery, or transureteral lithotripsy--which method? Comparison of ureteral stone management outcomes.
OBJECTIVE
The optimal treatment option for ureteral calculi is a controversial issue. In this study, we present our experience of 60 patients, divided into three groups, who were treated using open surgery, laparoscopic surgery, or transureteral lithotripsy (TUL).


METHODS
We enrolled 60 patients who had upper ureteral calculi >l0 mm in diameter from June 2008 to August 2009 in our center. In a prospective study, preoperative and postoperative data were evaluated, and for statistical analyses, the chi-square test, one-way analysis of variance, and post hoc test were used.


RESULTS
The mean operative time was 70, 191, and 162.5 minutes in the TUL, laparoscopic, and open groups, respectively. The mean hospital stay was 1.65, 4.2, and 4.35 days in the three groups, respectively. The stone-free rate was 90%, 95%, and 100% in the three groups, respectively. Flank pain was reported as 15%, 5%, and 15%, in the three groups, respectively. Hemoglobin decrease necessitating blood transfusion was not reported in the TUL and laparoscopic groups, but blood transfusion was reported in 15% in the open group. The lowest dose of analgesic was used in the TUL group. There was no damage to the ureter and adjacent organs and wound infection in the three groups.


CONCLUSIONS
Our study showed that the complications after laparoscopic surgery were lower than in open surgery. We recommend laparoscopic surgery for upper ureteral stones >1 cm because of lower postoperative complications, shorter hospital stay, and shorter time to convalescence, and better cosmetic results.
Urology Research Center, Guilan University of Medical Science, Rasht, Islamic Republic of Iran. falahatkar_s@yahoo.com
Siavash
S
Falahatkar
Iradj
I
Khosropanah
Aliakbar
A
Allahkhah
Azadeh
A
Jafari
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D019990:Perioperative Care; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014514:Ureteral Calculi / Q000601:surgery*