Treatment of urolithiasis: currently is there any space for laparoscopy?

Abstract

Introduction: The development of minimal access techniques in the treatment of urolithiasis has changed the management of this condition today; however the therapeutic challenge remains in patients with complex stones in proximal ureter and renal pelvis in which laparoscopic surgery is a good option. Materials and Methods: 10 patients were treated during the first half of 2016, whith diagnosis of complex pelvic lithiasis and proximal ureteral stones (> 15 mm); laparoscopic surgery was indicated. The mean age was 38 years (± 11.66). The location of these lithiasis was 8 proximal ureter and 2 in the renal pelvis. Results: Operative time ranged from 65 minutes to 270 minutes; the mean blood loss was 31.25 cc (± 6.29), drain production on the first day was between 36 ml - 45 ml. Postoperative pain on the first day after surgery was 3.5 (VAS) (± 2.22). The cosmetic result was very satisfactory for all, with an average of 9.5 (± 0.05). stone-free rate was 100%. Discussion: The management of bulky proximal ureteral stones or complex pyelic stones are a challenge because of its low stone-free rate either with ureterorenoscopy or external shock wave lithotripsy; an option for treating this type of stones is laparoscopic surgery, with a stone-free rate up to 100% in a single session and improving parameters such as hospital stay, requirement for additional analgesic treatment, early recovery, and cosmetic results. Conclusions: In complex situations ureteral or pyelic stones are successfully treated through laparoscopic approach, being an ideal choice to replace the open approach and endoruologic methods in selected cases.