Combined laparoscopic ureterolithotomy and flexible ureteroscopy for removing large upper ureteral stones with ipsilateral concurrent renal stones in selected patients

Objectives: The objective of this study is to report our experience of combined laparoscopic ureterolithotomy (LU) and flexible ureteroscopy for removing large upper ureteral stones with ipsilateral concurrent renal stones in selected patients and evaluated its advantages and potential. Methods: This retrospective study included 31 patients who underwent combined LU and flexible ureteroscopy for removing large upper ureteral stones and ipsilateral concurrent renal stones in our department from January 2014 to April 2017. For each patient, detailed medical history, demographics, and stone characteristics were collected. Procedure-related parameters, including stone-free rate, operation time, hospital stay after surgery, duration of drainage, mean estimated blood loss, visual analog scale (VAS) score, and complication rate, were evaluated. Results: The mean size of ureteral stones was 20.13 +/- 4.01 mm. The mean number of stones removed per patient was 4 (range: 2-7). All the procedures were completed laparoscopically with no open conversions. The total SFR was 90.3%, and the SFR of ureteral stones was 100%. The operation time was 110.4 +/- 26.5 minutes. Median hospital stay after surgery was 4 (range: 3-6) days, and the median duration of drainage was 4 (range: 3-5) days. The mean estimated blood loss was 16.5 +/- 9.1 mL. The mean VAS scores obtained at 24 and 48 hours after surgery were 2.53 +/- 0.91 and 1.08 +/- 0.45, respectively. No intraoperative complications were noted. The complication rate was 29.0%. Prolonged urine leakage was not detected. No ureteral strictures were detected in patients at follow-up visits 12 months after surgery. Conclusion: As a safe and minimally-invasive procedure, combined LU and flexible ureteroscopy is suitable for removing large upper ureteral stones along with ipsilateral concurrent renal stones. It provided high SFRs and low complication rates in these patients.