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Laparoscopic management of distal ureteric stones in a bilharzial ureter: Results of a single-centre prospective study.

Nour HH, Elgobashy SE, Elkholy A, Kamal AM, Roshdy MA, Elbaz AG, Riad E - Arab J Urol (2015)

Bottom Line: The stone recurred in four patients and a ureteric stricture was reported in two.All patients were rendered stone-free.Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.

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.

Patients and 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.

Conclusion: Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.

No MeSH data available.


Related in: MedlinePlus

The important surgical steps in transperitoneal LU: (1) Proximal control of the ureter; (2) Ureteric pinching.
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f0005: The important surgical steps in transperitoneal LU: (1) Proximal control of the ureter; (2) Ureteric pinching.

Mentions: The procedure usually starts with cystoscopy and insertion of an open-tip 6 F ureteric catheter, and then the stone side is laterally tilted to 45°. The LU was performed through four ports, comprising two 10-mm and two 5-mm trocars. After reflecting the colon, the ureter was identified and the stone located and extracted through vertical ureterotomy. The stone was identified by an obvious bulge, or pinching by Maryland forceps. Upward migration of the stone was prevented by applying a laparoscopic Babcock forceps on the ureter above the stone bulge, which was replaced by a vessel tape in some cases, according to the surgeon’s preference. This was followed by ureterotomy and stone extraction (Fig. 1). A 6 F JJ stent was then inserted and the ureterotomy closed with 4/0 polyglactin sutures. Using a 5-mm endoscope, the stone was extracted in a sac through the 10-mm port and then a small drain was inserted via the other 5-mm port.


Laparoscopic management of distal ureteric stones in a bilharzial ureter: Results of a single-centre prospective study.

Nour HH, Elgobashy SE, Elkholy A, Kamal AM, Roshdy MA, Elbaz AG, Riad E - Arab J Urol (2015)

The important surgical steps in transperitoneal LU: (1) Proximal control of the ureter; (2) Ureteric pinching.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563007&req=5

f0005: The important surgical steps in transperitoneal LU: (1) Proximal control of the ureter; (2) Ureteric pinching.
Mentions: The procedure usually starts with cystoscopy and insertion of an open-tip 6 F ureteric catheter, and then the stone side is laterally tilted to 45°. The LU was performed through four ports, comprising two 10-mm and two 5-mm trocars. After reflecting the colon, the ureter was identified and the stone located and extracted through vertical ureterotomy. The stone was identified by an obvious bulge, or pinching by Maryland forceps. Upward migration of the stone was prevented by applying a laparoscopic Babcock forceps on the ureter above the stone bulge, which was replaced by a vessel tape in some cases, according to the surgeon’s preference. This was followed by ureterotomy and stone extraction (Fig. 1). A 6 F JJ stent was then inserted and the ureterotomy closed with 4/0 polyglactin sutures. Using a 5-mm endoscope, the stone was extracted in a sac through the 10-mm port and then a small drain was inserted via the other 5-mm port.

Bottom Line: The stone recurred in four patients and a ureteric stricture was reported in two.All patients were rendered stone-free.Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.

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.

Patients and 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.

Conclusion: Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.

No MeSH data available.


Related in: MedlinePlus