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Retroperitoneal laparoscopic ureterolithotomy for proximal ureteral calculi in selected patients.

Hu Q, Ding W, Gou Y, Ho Y, Xu K, Gu B, Sun C, Xia G, Ding Q - ScientificWorldJournal (2014)

Bottom Line: All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL.The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%.Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Huashan Hospital, Fudan University, No. 12 Central Urumqi Road, Shanghai 200040, China ; Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China ; Department of Surgery, Shanghai Medical College, Fudan University, Shanghai 200040, China.

ABSTRACT

Objectives: To summarize our experience of retroperitoneal laparoscopic ureterolithotomy for ureteral calculi and evaluate the safety and efficiency of this procedure.

Methods: We conducted a retrospective analysis of 197 patients with proximal ureteral calculi who accepted retroperitoneal laparoscopic ureterolithotomy from June 2005 to June 2014.

Results: All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL. The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%.

Conclusions: Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients.

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Related in: MedlinePlus

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Mentions: All the operations were performed by one experienced surgeon (Guowei Xia) who did well in urologic laparoscopic surgery. LU was conducted by the conventional three ports procedure under a lateral decubitus position with hyperextension, which was reported in our previous similar study [8]. To establish working space, the fascia lumbodorsalis was divided by a hemostatic forceps through a 2 cm incision over the iliac crest, and the retroperitoneal fat and the retroperitoneal space were separated by the digital dissection and balloon dilatation. Two ports were guided by index finger and placed at the subcostal anterior and posterior axillary line, and the port of camera was at the former incision over the iliac crest. The ureteral stone could be identified along the bulge of ureter in the area anterior to the psoas major muscle after opening Gerota's fascia and renal capsule. The ureteral stone was extracted from a longitudinal incision, and a 6F D-J stent (Cook Medical) was inserted routinely (Figure 2). The method used to insert D-J stent was similar to that mentioned by Fan and colleagues [9]. Then the ureteral incision could be closed by interrupted sutures. A retroperitoneal drain was inserted and removed once it was below 20 mL, and the D-J stent would be extracted 3-4 weeks later by cystoscopy.


Retroperitoneal laparoscopic ureterolithotomy for proximal ureteral calculi in selected patients.

Hu Q, Ding W, Gou Y, Ho Y, Xu K, Gu B, Sun C, Xia G, Ding Q - ScientificWorldJournal (2014)

© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4273536&req=5

Mentions: All the operations were performed by one experienced surgeon (Guowei Xia) who did well in urologic laparoscopic surgery. LU was conducted by the conventional three ports procedure under a lateral decubitus position with hyperextension, which was reported in our previous similar study [8]. To establish working space, the fascia lumbodorsalis was divided by a hemostatic forceps through a 2 cm incision over the iliac crest, and the retroperitoneal fat and the retroperitoneal space were separated by the digital dissection and balloon dilatation. Two ports were guided by index finger and placed at the subcostal anterior and posterior axillary line, and the port of camera was at the former incision over the iliac crest. The ureteral stone could be identified along the bulge of ureter in the area anterior to the psoas major muscle after opening Gerota's fascia and renal capsule. The ureteral stone was extracted from a longitudinal incision, and a 6F D-J stent (Cook Medical) was inserted routinely (Figure 2). The method used to insert D-J stent was similar to that mentioned by Fan and colleagues [9]. Then the ureteral incision could be closed by interrupted sutures. A retroperitoneal drain was inserted and removed once it was below 20 mL, and the D-J stent would be extracted 3-4 weeks later by cystoscopy.

Bottom Line: All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL.The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%.Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Huashan Hospital, Fudan University, No. 12 Central Urumqi Road, Shanghai 200040, China ; Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China ; Department of Surgery, Shanghai Medical College, Fudan University, Shanghai 200040, China.

ABSTRACT

Objectives: To summarize our experience of retroperitoneal laparoscopic ureterolithotomy for ureteral calculi and evaluate the safety and efficiency of this procedure.

Methods: We conducted a retrospective analysis of 197 patients with proximal ureteral calculi who accepted retroperitoneal laparoscopic ureterolithotomy from June 2005 to June 2014.

Results: All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL. The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%.

Conclusions: Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients.

Show MeSH
Related in: MedlinePlus