Laparoscopic ureterolithotomy: the method of choice in selected cases.

OBJECTIVE: To evaluate retrospectively the results and complication, efficacy, and safety rates of laparoscopic ureterolithotomy in the treatment of large, impacted ureteric stones. MATERIALS AND METHODS: Between September 1994 and December 2003, 73 patients underwent 75 laparoscopic ureterolithotomies (LUL). Mid- and upper-ureteric stones were removed retroperitoneally in 69 cases (92%). Lower ureteric stones were removed transperitoneally in 6 cases (8%). There were 2 (3%) bilateral LULs in one session, 7 (10%) ipsilateral percutaneous nephrolithotomy, and 6 (8%) ipsilateral ureteroscopy in the same session. The mean age of the patients was 39 years (range, 15-70 years). Mean stone size was 25 mm (range, 12-55 mm). RESULTS: The success rate was 98.7%, with 1 patient (1.3%) requiring conversion to an open procedure. There were no major complications. Mean operative time was 45 minutes (range, 15-100 minutes). Postoperative analgesic medication was required for 1 day in 39 patients (52%). The postoperative hospital stay ranged from 2 to 5 days (mean, 3 days). CONCLUSION: On the basis of our experience, laparoscopic ureterolithotomy is a safe and effective method for the treatment of large, dense, and impacted ureteric stones. In selected cases it can be the first choice of treatment.