A comparative study of sutureless versus sutured transperitoneal laparoscopic ureterolithotomy for large proximal ureteral stones: efficacy, safety, and perioperative outcomes.

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.