Is there still a place for surgery in the treatment of ureteral stones?

Although most ureteral stones can be treated with Extracorporeal Shock Wave Lithotripsy (ESWL) and endourology, there still is a small percent of patients whose stones can not be treated with minimally invasive techniques and thus require open surgery. Retroperitoneoscopic surgery is a good alternative for this subgroup of patients. It provides a direct access to the retroperitoneum, less morbid than an open operation and provides a better cosmetic result. On the very rare occasion open surgery with ureteral reimplantation to the bladder is required in those patients with lower ureteral stones. We have seen 1297 patients with stones larger than 5 mm in the ureter during the last 7 years. Among those undergoing watchful waiting 82% were stone-free; and that was 2.4% of all ureteral stones. Among those 1258 patients whom required a treatment 82.1% underwent in situ ESWL and 74.5% of them were rendered stone-free. In 8.9% of the patients ureteroscopy was performed (50% primary, and 50% for failed ESWL) with a stone-free rate of 75.8%. Open stone surgery was required in 8.9%, and retroperitoneoscopic surgery for ureteral stones was performed in only 0.15% of all patients. The best form of treatment for a ureteral stone is watchful waiting and the patient passing the stone without any intervention. Although that is the best scenario, this is a very painful condition and unfortunately most patients require some form of treatment. While ESWL for upper and mid ureteral non-obstructing and non-impacted stones is highly effective, stones in the lower ureter can be successfully treated via ureteroscopy. There still are some patients who require open surgery and retroperitoneoscopic surgery can be an alternative for this subgroup of patients offering a less morbid and better cosmetic result.