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

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.