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Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?
Author(s) -
Sharma D.M.,
Maharaj D.,
Naraynsingh V.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04438.x
Subject(s) - medicine , surgery , ureter , refractory (planetary science) , nonsteroidal , blood loss , physics , astrobiology
OBJECTIVE To report the experience in one centre of the efficacy and safety of open mini‐access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODS MAU was undertaken in 112 patients (mean age 38 years, range 26–57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8–22) mm, with 30 stones in the upper, 69 in the mid‐ and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. RESULTS MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10–44) min and the hospital stay 42 (24–72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30–150) mL. The drain was removed after 5 (5–7) days. Patients reported using opioid or nonsteroidal anti‐inflammatory analgesia for a mean of 4 (1–7) days after surgery. The mean time to resumption of work was 16 (8–35) days. CONCLUSIONS MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first‐line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first‐line treatment.