ABSTRACT
Objective: This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy
(LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the
proximal ureter.
Material and methods: A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal
ureter was selected and randomly divided into two groups. The frst group included 13 patients who were treated by
LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.
Results: There was no signifcant difference between the two groups regarding patient demographics and stone
characteristics. The mean operative time was signifcantly shorter in the LTU group than in the LRU group
[116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was signifcantly longer
in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was signifcant
higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was signifcantly higher in the
LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically signifcant
difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood
transfusion rate, postoperative fever, and stone migration during surgery.
Conclusion: Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in
the proximal ureter. LTU has signifcantly shorter operative time and lower rate of open conversion but has a signifcantly longer time to oral intake.