OVERVIEW

The extraction of stones in the urinary tract can be carried out through several surgical treatment options. Among these modalities are: endoscopy (see endourology), percutaneous surgery, open surgery and laparoscopy.

The reasons for removing a stone by laparoscopy are:

  • Stones in the kidney of large volume (greater than 2 cm)
  • Stones in the large volume ureter (greater than 2 cm)
  • Need to perform a reconstructive procedure of the renal pelvis during the same surgery as a pyeloplasty
  • Ureteral stricture that does not allow the passage of the ureteroscope to the kidney cavities
  • Failure in the previous endoscopic treatment
  • Removal of catheter JJ calcified by prolonged stay

Benefits of urinary stone extraction by laparoscopy

When urinary tract stones are removed, urine infection is prevented, and pain is relieved.

When performed by laparoscopy, the extraction of renal / ureteral stones are surgeries that offer rapid recovery and little postoperative pain.

Sometimes the stones in the kidneys can be very voluminous (staghorn calculi) and several surgeries are required for their complete removal, in these cases can combine several surgical modalities such as laparoscopy and endourology to achieve total kidney cleansing.

If a stone is in the ureter and it is large, it is preferable to remove it by laparoscopy to avoid sequelae such as ureteral narrowing by prolonged endoscopic surgery.

Risks and complications

The possible complications that may occur when performing a pyelolithotomy / ureterolithotomy are the same that can occur in general with any surgical procedure and these are: hemorrhage, damage to nearby organs, reactions to anesthesia, etc; However, these complications occur infrequently and can be resolved mostly during the same surgery.

The risk of conversion to open surgery is low, (<5%), this may be due to difficulty in the dissection or removal of the kidney stone and is performed to maintain patient safety.

Another risk of pyelolithotomy or ureterolithotomy is that not all the fragments of the stone are completely extracted in a single surgery, this occurs when the stones are very large (staghorn calculi) or when the anatomy of the kidney is very complex, in these cases it is recommended complete the extraction by combining laparoscopic, endoscopic and / or percutaneous surgery

Alternatives to laparoscopic pyelolithotomy / ureterolithotomy

The extraction of stones in the urinary tract can be performed by semi-rigid ureteroscopy, retrograde intrarenal surgery (RIRS) by fragmenting the stones with laser energy, by percutaneous kidney surgery or by open surgery. In some cases, the stones are small enough (<4mm) to leave through the urinary tract without the need for surgery.

What to expect from laparoscopic pyelolithotomy / ureteroscopy?

Day of surgery:

The day of the operation will arrive in the morning to the hospital in fasting.

The surgery lasts approximately 2 -3 hours; however, the time is variable.

Anesthesia for this procedure is general, so you will be unconscious during surgery.

Pain after laparoscopic pyelolithotomy / ureterolithotomy is minimal and can be effectively controlled with analgesics administered through the vein.

Food: on the day of surgery you can eat in the afternoon, there are no food restrictions, however, a balanced diet is recommended.

Physical activity: the same day of surgery you can walk in the afternoon. It is expected to feel a bit fatigued after any surgery, this problem resolves spontaneously within a few weeks after the laparoscopic pyelolithotomy / ureteroscopy.

Hospital stay: most patients undergoing laparoscopic nephrectomy remain hospitalized for 2 to 3 days.

Wounds: laparoscopy pyelolithotomy / ureterolithotomy requires 3 small incisions in the abdomen (each 1 cm or less), once they are completely healed, these scars can rarely be seen. The stone is extracted through one of these incisions.

Catheter: after removing the stone, a JJ stent is inserted into the ureter, which remains after surgery for 6 weeks to facilitate uniform healing of the urinary tract, this stent is not visible because it is inside the body, however, some patients perceive mild discomforts such as burning during urination, mild pain in the back, mild hematuria (blood in the urine) and urgency (frequent urination), the removal of this catheter is by endoscopy and can be performed as an outpatient procedure in an office.

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