Comparative study of transperitoneal laparoscopic versus retroperitoneoscopic ureterolithotomy techniques

Abstract

Purpose: This study evaluated the effectiveness and safety of transperitoneal laparoscopic ureterolithotomy (TPLU) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the surgical management of ureterolithiasis. Materials and Methods: The current prospective study was conducted at the Department of Urology, Dr. D. Y. Patil Medical College. The complete patient medical history including patient's age, sex, stone (size, number, and laterality), and past history of stone surgeries were evaluated. Based on the treatment method, the patients were divided into TPLU and RPLU group. Both the procedures were evaluated for parameters including operative technique, operating time, hospital stay, intra- and postoperative complications, conversion rate, success rate, and surgical ergonomics. Results: A total of 50 patients were included (TPLU, n = 25; and RPLU, n = 25). The average age was 43.6 years in the TPLU and 46.7 years in the RPLU group. The average size of calculi was >15 mm in both the groups. The operation time and blood loss were relatively higher in the TPLU group than RPLU group. The complete stone clearance was observed in both the groups. The pain in loin area and burning micturition were the most common complaints reported by the patients from both the groups. One patient from RPLU group was converted to open surgery. The calculi size in TPLU group was positively correlated with operative time (r = 0.535, P = 0.006), blood loss (r = 0.440, P = 0.028), and hospital stay (r = 0.430, P = 0.032). Conclusion: TPLU and RPLU are feasible techniques for the management of large ureteric stones that are not amenable to ureteroscopy or extracorporeal shockwave therapy.