Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica · 2026
A comparative study of sutureless versus sutured transperitoneal laparoscopic ureterolithotomy for large proximal ureteral stones: efficacy, safety, and perioperative outcomes.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Eslahi Seyed Ali, Hosseini Seyed Hossein, Shamohammadi Iman, Akbarian Ali, Adib Ali, Karama Mazen, Ahmed Faisal
Аннотация
BACKGROUND: Laparoscopic ureterolithotomy (LU) is a standard intervention for large proximal ureteral stones. A significant technical consideration is whether to suture the ureterotomy site or utilize a sutureless approach to potentially minimize operative time and surgical morbidity. This study aimed to compare the perioperative outcomes and safety profiles of sutureless vs conventional sutured transperitoneal LU.
METHODS: We conducted a retrospective comparative study of 60 patients with proximal ureteral stones >15 mm who underwent transperitoneal LU between January 2023 and March 2025. Patients were divided into two groups: a sutured group (n=30), where the ureterotomy was closed with interrupted sutures, and a sutureless group (n=30), where the site was left unsutured over a Double-J stent. Primary and secondary outcomes included operative time, urinary leakage volume (measured via drain output), hospital stay, and postoperative renal function.
RESULTS: Baseline demographics and stone characteristics were comparable between the groups. The sutureless technique was associated with a significantly shorter mean operative time (2.2±0.3 h vs 2.7±0.4 h; p<0.001). While the duration of ureteral stenting was statistically longer in the sutureless group (17.7±4.4 days vs 16.1±5.2 days; p=0.050), this difference was clinically marginal. There were no significant differences in the volume of postoperative urinary leakage (p=0.066), hospital stay, or changes in serum creatinine and hemoglobin levels. No cases of urinoma or ureteral stricture were observed in either cohort during the early follow-up period.
CONCLUSIONS: The sutureless technique for laparoscopic ureterolithotomy is a safe and efficient alternative that significantly reduces operative time without increasing the risk of major complications. Although it involves a statistically longer stenting period, the overall clinical outcomes are comparable to the sutured technique. The choice of approach should be individualized based on surgeon expertise and patient-specific anatomical factors.
METHODS: We conducted a retrospective comparative study of 60 patients with proximal ureteral stones >15 mm who underwent transperitoneal LU between January 2023 and March 2025. Patients were divided into two groups: a sutured group (n=30), where the ureterotomy was closed with interrupted sutures, and a sutureless group (n=30), where the site was left unsutured over a Double-J stent. Primary and secondary outcomes included operative time, urinary leakage volume (measured via drain output), hospital stay, and postoperative renal function.
RESULTS: Baseline demographics and stone characteristics were comparable between the groups. The sutureless technique was associated with a significantly shorter mean operative time (2.2±0.3 h vs 2.7±0.4 h; p<0.001). While the duration of ureteral stenting was statistically longer in the sutureless group (17.7±4.4 days vs 16.1±5.2 days; p=0.050), this difference was clinically marginal. There were no significant differences in the volume of postoperative urinary leakage (p=0.066), hospital stay, or changes in serum creatinine and hemoglobin levels. No cases of urinoma or ureteral stricture were observed in either cohort during the early follow-up period.
CONCLUSIONS: The sutureless technique for laparoscopic ureterolithotomy is a safe and efficient alternative that significantly reduces operative time without increasing the risk of major complications. Although it involves a statistically longer stenting period, the overall clinical outcomes are comparable to the sutured technique. The choice of approach should be individualized based on surgeon expertise and patient-specific anatomical factors.