Progress of laparoscopic surgery
Using a retroperitoneal or transperitoneal approach, the surgeon finds the ureter, fixes it above the stone (so that the stone does not move into the kidney), longitudinally dissects the wall above the stone and removes it entirely into a container. The ureter is sutured with thin absorbable sutures on a stent placed antegradely or in advance. The drainage is removed after 2–3 days, the stent after 2–4 weeks. Blood loss is minimal, puncture marks are hardly noticeable; You can return to work in 10–14 days.
When a ureteral stone is removed by surgery
Today, almost all ureteral stones are removed endoscopically or ESWL. Ureterolithotomy is needed when these methods are impossible or unsuccessful: a large (more than 1.5–2 cm) dense impacted stone, standing for a long time in the upper third with edema and stricture below; a stone due to abnormalities of the ureter, after unsuccessful lithotripsy sessions, if it is impossible to carry out a ureteroscope. The advantage is that the entire stone is removed at one time without fragments.
After surgery
The ureter is sutured on a stent, which is removed after 2–4 weeks; drainage - on the 2-3rd day, when the discharge stops. After laparoscopy, discharge is on the 3-4th day, after open surgery - on the 5-6th. Control ultrasound after 1 and 3 months checks the patency of the ureter; the risk of stricture in the incision area is 2–5%. The stone is sent for composition analysis to select prophylaxis.
