Is Open Ureterolithotomy Finished? : A Case of Giant Ureteral Stone and Screening of the Literature

Year 2024, , 18 - 20, 30.04.2024

Tayfun Çifteci

https://doi.org/10.56150/tjhsl.1250253

Abstract

INTRODUCTION: Open surgery is an old method of urology in the treatment of ureteral stones. With the development of new technologies; Indications for open surgery in the treatment of stone disease have decreased to 1-5.4 %. In this case, we aimed to remove 4 stones with a diameter of 22 mm at the lower end of the left ureter by open ureterolithotomy and to report similar cases in the literature.
CASE: In the direct urinary system X-ray and abdominal computed tomography of the patient who applied to us with the complaint of left flank pain, 4 stones with a diameter of 22 mm in the lower end of the left ureter, grade 4 hydroureteronephrosis in the left ureter and kidney were observed. Left open ureterolithotomy was planned. The patient's stones were removed using the left Gibson incision technique, and the ureteral incision area was sutured by placing a 6f double j catheter into the ureter. A drain was placed in the left ureteral tracing and the procedure was terminated by suturing the Gibson incision. The patient's foley catheter was removed on the 1st day and the drain was removed on the 2nd day, and he was discharged. No postoperative complications were encountered. Six weeks later, the patient's 6f double j catheter was removed and the surgical procedure was completed.
DISCUSSION: Ureteral stones usually form in the primary kidney and then descend into the ureter. Ureteral stones usually pass spontaneously, but stones larger than 1 cm have fewer spontaneous passages. Ureteral stones are usually single and smaller than 2 cm. For stones larger than 5 cm, the term giant ureteral stone is used. Paik et al. reported a mean blood loss of 144 cc and a mean hospital stay of 6.5 days in seven patients with open ureterolithotomy. All patients in the series were stone-free and had no complications. In another study, open ureterolithotomy was performed in 56 patients, and 46.4% of the patients had stones in the distalureter. While the hospital stay was 4.2 days, no complications were encountered.
CONCLUSION: Open ureterolithotomy has lost its status as the gold standard with the development of ureterorenoscopy, but as in our case, it is a surgical technique that should be considered in large ureteral stones.

Keywords

URETERAL STONE, URETEROLITOTOMY, URETERAL SURGERY

References

• Assimos DG, Boyce WH, Harrison LH, Mc-Cullough DL, Kroovand RL, Sweat KR. The role of open stone surgery since extracorporeal shock wave lithotripsy. J Urol 1989;142(2Pt 1):263-7.
• Bichler KH, Lahme S, Strohmaier WL. Indications for open stone removal of urinary calculi. UrolInt 1997;59(2):102-8.
• Honeck P, Wendt-Nordahl G, Krombach P,Bach T, Häcker A, Alken P, et al. Does open stone surgery still play a role in the treatment of urolithiasis? Data of a primary urolithiasis center. J Endourol 2009;23(7):1209-12.
• Turk C, Knoll T, Petrik, Sarica K, Skolarikos A, Straub M, Seitz C.Guidelines on Urolithiasis. Austria: EAU; 2014.
• Sutor DJ and Wooley SE. Somedata on urinary stones which were passed. Brit J Urol1975;47:131-134.
• Arslan H, Sisman E, Ünal Ö, Harman M. Dev üreter tası: Olgu bildirisi. Van Tıp Dergisi 1999;6:27-29.
• Tuncel E. Klinik Radyoloji, 1. Baskı. Bursa: Günes Nobel, 1994: 398-402.
• Ödev K. Üriner Sistem Radyolojisi, I. Baskı, Konya: Atlas Tıp Kitabevi, 1992: 1352-1372.
• Jouini R, Maazoun K, Sahnoun L, et al. Giant ureteric stones:report of two cases. ProgUrol2005;15:505-510.
• Paik ML, Wainstein MA, Spirnak JP, Hampe IN, Resnick MI. Current indications for open stone surgery in the treatment of renal and ureteral calculi. J Urol 1998;159(2):374-8; discussion 378-9.
• Goel A, Hemal AK. Upper and mid-uretericstones: a prospective unrandomized comparison of retroperitonoscopic and open ureterolithotomy. BJU Int 2001;88(7):679-82.
• Muslumanoglu AY, Karadag MA, Tefekli AH, Altunrende F, Tok A, Berberoglu Y. When is open ureterolithotomy indicated for the treatment of ureteralstones? Int J Urol 2006; 13(11):1385-8.