title: Laparoscopic ureterolithotomy as a primary modality for large proximal ureteral calculi: comparison to rigid ureteroscopic pneumatic lithotripsy.
abstract: OBJECTIVE
  To define the role of laparoscopic ureterolithotomy (LU) as a primary modality for large proximal ureteral stones, we compared the outcomes of primary LU with those of ureterorenoscopy (URS), the currently established modality in this circumstance.
  
  
  METHODS
  Among 71 patients who underwent LU in our institution between February 2005 and January 2010, 32 patients with stone size over 1.5 cm who underwent LU as a primary modality without prior shockwave lithotripsy or URS and for whom LU was conducted as a separate procedure were exclusively enrolled. Based on preoperative characteristics of patients and stones, this patient group was matched with the URS group (n = 32, rigid pneumatic lithotripter) during the same period.
  
  
  RESULTS
  The LU group and the URS group were similar in age, gender distribution, body mass index, stone size (18.1 ± 4.2 versus 17.9 ± 3.6 mm; P = .88), and stone location. Members of the LU group required a longer operative time (118 ± 53 versus 59 ± 41 minutes; P < .001) and hospital stay (5.9 ± 2.1 versus 3.4 ± 2.4 days; P < .001) and had greater blood loss (155 ± 62 mL). However, stone clearance rate (no remnant stone in postoperative X-ray of the kidney, ureter, and bladder) in a single session was marginally higher in the LU group (93.8% versus 68.8%; P = .06). Total complication rate was not significant and was slightly higher in the URS group (12.5% versus 21.9%, P = .51). Stone migration into the kidney (n = 2 versus 5), ureteral perforation (n = 0 versus 3), open conversion (n = 1 versus 2), and ureteral stricture (n = 1 versus 2), as long-term complications, occurred more frequently in the URS group.
  
  
  CONCLUSIONS
  For large proximal ureteral stones, LU can be conducted safely as a first-line procedure without increase of complication rate, compared with conventional URS. Although LU required a prolonged operative time and a longer hospital stay and blood loss was greater, our data showed an advantage of LU in high clearance rate in a single procedure.
authors.affiliation: Department of Urology, Korea University School of Medicine, Seoul, Korea.
authors.forename: Young Hwii
authors.initials: YH
authors.lastname: Ko
authors.forename: Sung Gu
authors.initials: SG
authors.lastname: Kang
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Park
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.forename: Dae Yeon
authors.initials: DY
authors.lastname: Cho
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Jun
authors.initials: J
authors.lastname: Cheon
authors.forename: Jeong Gu
authors.initials: JG
authors.lastname: Lee
authors.forename: Je Jong
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*