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Abstract

Background:Ureteric stone disease remains a significant urological concern, with larger or impacted stones often refractory to non-invasive techniques such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy. Laparoscopic ureterolithotomy, particularly via the transperitoneal approach, has emerged as a minimally invasive alternative in such cases.
Objectives:To evaluate the safety and efficacy of laparoscopic transperitoneal ureterolithotomy in patients with large proximal and mid-ureteric stones.
Methods:This prospective observational study included 50 patients aged 20–60 years with proximal or mid-ureteric calculi >1.5 cm. Patients underwent laparoscopic transperitoneal ureterolithotomy using a standardized three-port technique. Key intraoperative and postoperative outcomes were recorded, including operative time, blood loss, conversion to open surgery, postoperative pain (VAS score), drain duration, hospital stay, and surgical complications.
Results:The mean patient age was 40.7 ± 11.8 years, with a male-to-female ratio of 1.17:1. Most stones were located in the left proximal ureter (64%) and had a mean size of 1.7 cm. The average operative time was 90.2 ± 28.5 minutes, and mean intraoperative blood loss was 74.7 ± 33.8 mL. Conversion to open surgery occurred in 14% of cases. Postoperative pain scores averaged 5.8 ± 2.2 on the VAS scale, and the mean hospital stay was 8.5 ± 3.2 days. Complications were minimal, with 18% developing surgical site infections and only 6% experiencing injury to adjacent structures.
Conclusion:Laparoscopic transperitoneal ureterolithotomy is a safe and effective modality for the treatment of large upper and mid-ureteric stones. The procedure is associated with favorable operative outcomes, minimal complications, and good postoperative recovery, supporting its use as a viable alternative to open surgery or repeated endoscopic interventions in selected patients.