Ces Urol 2021, 25(3):204-212 | DOI: 10.48095/cccu2021026

The place of laparoscopy in the surgical treatment of urolithiasis

Michaela Motolová

Urologie, Barmherzige Schwestern Krankenhaus Wien

Motolová M. The place of laparoscopy in the surgical treatment of urolithiasis.

Objective: The aim of this case study is to show the advantages of laparoscopic management for therapy of complex and large pelvi-/uretherolithiasis, particularly in situations where an endoscopic approach is not successful or feasible. Simultaneously it should encourage the experienced laparoscopic surgeons to broaden their fields of interest to the therapy of urolithiasis.

Methods: This single-center, retrospective study presents data collected from 02/2017 to 02/2021. Inclusion criteria: Primary laparoscopic access for therapy of lithiasis in upper urinary tract in a single session. Altogether 16 patients were subsumed - with these indications: 2× pyelolitomy (PL) for calculi in one-half of a horseshoe kidney, 5× PL for solitary large renal pelvic stones, 2× ureterolithotomy (UL) for management of large proximal ureteric stones 1× UL in the indication of an encrusted ureteral stent, with maximum stone - mass in distal ureteral portion. 6× pyeloplasty with concomitant pyelolithotomy. Primary endpoint was the evaluation of effectivity of the laparoscopic procedures based on stone free rate, operative time, complication-rate and recovery time. Secondary endpoint was the comparision with endoscopy - retrograde intrarenal surgery and percutaneus nephrolithotomy.

Results: Stone free results were achieved in all cases of our study - 100% in only 1 session. Average OP time was 42 minutes. The maximal grade of complications according to the Clavien-Dindo classification was Grade I. Age range of patients: from 24 to 78 years. Average hospitalization time was 4 days. No additional radiation exposure of patients was necessary.

Conclusion: Laparoscopic stone surgery is reserved for extraordinary situations, in rare cases of selected patients. In expert hands it is a safe and minimally invasive modality with high efficacy, therefore is of growing interest to urologists all over the world.

Keywords: Laparoscopy, pyelolithotomy +/- pyeloplasty, ren arcuatus, ureterolithotomy.

Received: January 14, 2021; Revised: May 2, 2021; Accepted: March 24, 2021; Prepublished online: June 7, 2021; Published: September 30, 2021