Urology Annals

LETTER TO THE EDITOR
Year
: 2012  |  Volume : 4  |  Issue : 3  |  Page : 195--196

Comment on: Laparoscopic transperitoneal ureterolithotomy for large ureteric stone


Mohd. Nazli Kamarulzaman 
 Urology Unit, Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia

Correspondence Address:
Mohd. Nazli Kamarulzaman
Consultant Urologist, Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Penjara, 25100 Kuantan, Pahang Darul Makmur
Malaysia




How to cite this article:
Kamarulzaman M. Comment on: Laparoscopic transperitoneal ureterolithotomy for large ureteric stone.Urol Ann 2012;4:195-196


How to cite this URL:
Kamarulzaman M. Comment on: Laparoscopic transperitoneal ureterolithotomy for large ureteric stone. Urol Ann [serial online] 2012 [cited 2019 Nov 17 ];4:195-196
Available from: http://www.urologyannals.com/text.asp?2012/4/3/195/102679


Full Text

Sir,

I read with great interest the article titled "Laparoscopy transperitoneal ureterolithotomy for large ureteric stone" by Al-Sayyad. [1] The report is very informative, with some insight into the current trend of large proximal ureteric stone management. I have some comments on this work. Due to the nature of retrospective study, the value of this report is limited. The author did not define the meaning of large proximal ureteric stone clearly. In most of previous studies this classification was precise in term of size and site of ureteric stone. As an example Geol et al. [2] classify it as stone located between the ureteropelvic junction and the lower border of the 4 th lumbar vertebra, whereas Cengiz et al. [3] use 5 cm distal to the ureteropelvic junction. Goel et al. [2] found that the best option for those types of stone is percutaneous nephrolithotomy (PCNL) which give stone free rate of 98.5%. This success rates were almost similar to laparoscopic ureterolithotomy done by the author. [1] In contrast the laparoscopic ureterolithotomy in this study showed higher morbidity in comparison to the PCNL in Goel et al. [2] These shown by longer operative time (mean of 90 vs. 47 minutes) and longer hospital stay (mean of 62.4 vs. 46 hours). [1],[2] If we treat the patient individually with precise diagnosis of site and size of stone, the choice of treatment mode will be more accurate. Endourology procedures are documented as minimal invasive procedure with very low morbidity, but highly operator dependent. I would say that the best option for stone located close to ureteropelvic junction (5 cm) is PCNL. This endourology procedure will give high success rate with reasonable morbidity in an expert hand. Laparoscopic ureterolithotomy only reserve for those cases which was contraindicated for PCNL.

References

1Al-Sayyad A. Laparoscopic transperitoneal ureterolithotomy for large ureteric stone. Urol Ann 2012;4:34-7.
2Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: Still the treatment of choice in developing countries. J Endourol. 2005;19:54-7.
3Elgganainy E, Hameed DA, Elgammal MA, Abd-Elsayed AA Shalaby M. Experience with impacted upper ureteral Stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast? Int Arach Med 2009;2:13.