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Abstract
Purpose
We evaluated the outcome of laparoscopic retroperitoneal ureterolithotomy (LRU) and compared the results with the rigid ureteroscopic removal of stones with the Lithoclast® (rigid URS) for the management of large upper ureteral stones (≥10 mm).
Materials and Methods
Between July 2002 and March 2008, rigid URS and LRU were performed in 37 and 24 patients, respectively. We evaluated the outcomes of each procedure and compared the success rate according to the location (above and below the L3 level by the third intervertebral disc of the lumbar spine) and size of the stones (10-15 mm and ≥15 mm in diameter).
Results
The overall success rate for rigid URS and LRU were 70.3% (26/37) and 91.7% (22/24), respectively (p=0.059). For rigid URS, the success rate was 50.0% (8/16) and 85.7% (18/21) for stones above and below the L3 level (p=0.030), respectively, and 85.7% (23/28) and 33.3% (3/9) for stones 10-15 mm and ≥15 mm in diameter, respectively (p=0.011). For LRU, the success rate was 92.3% (12/13) and 90.9% (10/11) for stones above and below the L3 level, respectively (p=0.902), and 50.0% (1/2) and 95.5% (21/22) for stones 10-15 mm and ≥15 mm in diameter, respectively.
Conclusions
LRU demonstrated a high success rate regardless of the location and size of the stones. The outcomes with rigid URS were more varied. These results suggest that LRU is a feasible alternative for large upper ureteral stones that are 15 mm or more in size or located above the intervertebral disc between the third and fourth lumbar vertebrae.
Figures and Tables
Table 1
The success rate according to the location and size of the stones after rigid ureteroscopic removal of stones with Lithoclast® or laparoscopic retroperitoneal ureterolithotomy for upper ureteral stones
URS: ureteroscopic removal of stones, LRU: laparoscopic retroperitoneal ureterolithotomy, a: rigid ureteroscopic removal of stones with Lithoclast®, b: chi-square test between rigid URS with Lithoclast® group and LRU group according to the location and size of stones, c: upper ureter stones located above intervertebral disc between 3rd and 4th lumbar vertebrae, d: upper ureter stones located below intervertebral disc between 3rd and 4th lumbar vertebrae, e: chi-square test according to the location of stones, f: chi-square test according to the size of stones
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