When open access is justified
A 6–8 cm incision is made in the projection of the stone determined by MSCT. The ureter is isolated, incised over the stone, the stone is removed, and the wall is sutured with a stent. With concomitant stricture, ureteroplasty is immediately performed. Open access is safer in case of infiltrate and purulent process (periureteritis), scars after radiation therapy and previous operations, as well as in patients with contraindications to pneumoperitoneum. Recovery: 5–6 days in hospital, 4 weeks of restrictions.
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.
