title: Laparoscopic management of distal ureteric stones in a bilharzial ureter: Results of a single-centre prospective study.
abstract: OBJECTIVE
  To determine the efficacy and safety of the laparoscopic management of an impacted distal ureteric stone in a bilharzial ureter, as bilharzial ureters are complicated by distal stricture caused by the precipitation of bilharzial ova in the distal ureter. These cases are associated with poorly functioning and grossly hydronephrotic kidneys that hinder the endoscopic manipulation of the coexistent distal high burden of, and long-standing, impacted stones.
  
  
  METHODS
  We used laparoscopic ureterolithotomy, with four trocars, to manage 51 bilharzial patients (33 men and 18 women; mean age 40.13 years) with distal ureteric stones. The ureter was opened directly over the stone and the stone was extracted. A JJ stent was inserted into the ureter, which was then closed with a 4-0 polyglactin running suture.
  
  
  RESULTS
  The mean stone size was 2.73 cm. Conversion to open surgery was required in only one patient. The mean operative duration was 92 min, the postoperative pain score was 20-60, the mean (range) number of analgesic requests after surgery was 1.72 (1-3), comprising once in 21 patients, twice in 23 and thrice in seven. The mean hospital stay was 2.74 days, and the total duration of follow-up was 7-12 months. The stone recurred in four patients and a ureteric stricture was reported in two. All patients were rendered stone-free.
  
  
  CONCLUSIONS
  Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Nour
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Samir E
authors.initials: SE
authors.lastname: Elgobashy
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Elkholy
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Kamal
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Mamdouh A
authors.initials: MA
authors.lastname: Roshdy
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmad G
authors.initials: AG
authors.lastname: Elbaz
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Essam
authors.initials: E
authors.lastname: Riad
keywords: Bilharzial ureter; LU, laparoscopic ureterolithotomy; Laparoscopy; Stone; Transperitoneal