title: Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy.
abstract: OBJECTIVE
  To evaluate the outcomes of conventional laparoscopic retroperitoneal ureterolithotomy (CL-RU) and retroperitoneal laparoendoscopic single site retroperitoneal ureterolithotomy (LESS-RU) for large, impacted upper ureteral stones.
  
  
  METHODS
  Between January 2008 and December 2010, 65 patients underwent conventional or LESS ureterolithotomy. CL-RU was performed in 42 patients. These patients were compared with the remaining 23 patients who underwent LESS-RU. Indications for the operations were obstructive or impacted ureteral stones larger than 15 mm in the middle or upper part of the ureter. The following parameters of CL-RU were compared with the LESS-RU: operative time, blood loss, transfusion rates, duration of analgesia, postoperative pain, hospitalization time, and time to return to normal activities.
  
  
  RESULTS
  No difference was observed between the below-mentioned, respective parameters of CL-RU and LESS-RU groups: mean operative time (74.1 vs 69.9 min, P = .54), blood loss (54.9 vs 56.1 mL, P = .49), transfusion rates (0% for both), and hospitalization time (3.1 vs 2.9 days, P = .61). Duration of analgesia in patients who underwent CL-RU was longer than those who underwent LESS-RU (5.2 vs 2.4 days, P = .001). Time to return to normal activities in CL-RU patients was also longer than LESS-RU patients (9.7 vs 6.4 days, P = .001). Compared to CL-RU, mean visual analogue scale (VAS) scores were lower during postoperative days 1, 2, and 3 in LESS-RU patients. Urine leakage was observed in 2 cases in each group.
  
  
  CONCLUSIONS
  LESS ureterolithotomy performed by adopting the retroperitoneal approach seems to be a safe, reliable, and minimally invasive procedure after failed shock wave lithotripsy or ureteroscopy (URS). Naturally, further prospective, randomized, and controlled studies on large samples are needed to test the effectiveness of this approach.
authors.affiliation: Department of Urology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. volkantugcu@yahoo.com
authors.forename: Volkan
authors.initials: V
authors.lastname: Tugcu
authors.forename: Abdulmuttalip
authors.initials: A
authors.lastname: Simsek
authors.forename: Taner
authors.initials: T
authors.lastname: Kargi
authors.forename: Hakan
authors.initials: H
authors.lastname: Polat
authors.forename: Bekir
authors.initials: B
authors.lastname: Aras
authors.forename: Ali Ihsan
authors.initials: AI
authors.lastname: Tasci
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000601:surgery*