Original Papers - Stones and Infections Open access

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

Authors

Published
4 March 2026
Section
Original Papers - Stones and Infections
DOI
10.4081/aiua.2026.14794

Abstract

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.

Keywords

Ethics Approval

This study was approved by the Ethics Committee of Shiraz University of Medical Sciences, Shiraz, Iran (Approval No. IR.SUMS.MED.REC.1403. 546)

Data Availability Statement

The data supporting this study's findings are available from the corresponding author upon reasonable request.

References

  1. 1. Zhang L, Zhang X, Pu Y, et al. Global, regional, and national burden of urolithiasis from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Clin Epidemiol. 2022;14:971-83. DOI: https://doi.org/10.2147/CLEP.S370591
  2. 2. Bai Y, Tang Y, Deng L, et al. Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy. BMC Urol. 2017; 17:75. DOI: https://doi.org/10.1186/s12894-017-0266-7
  3. 3. Zahirian Moghadam T, Pourfarzi F, Mohseni Rad H, Zandian H. Kidney stones among Iranian adults: Prevalence and socioeconomic inequality assessment in a cohort-based cross-sectional study. Health Sci Rep. 2022; 5:e877. DOI: https://doi.org/10.1002/hsr2.877
  4. 4. Parks JH, Coe FL. The financial effects of kidney stone prevention. Kidney Int. 1996; 50:1706-12. DOI: https://doi.org/10.1038/ki.1996.489
  5. 5. Meria P, Milcent S, Desgrandchamps F, et al. Management of pelvic stones larger than 20 mm: laparoscopic transperitoneal pyelolithotomy or percutaneous nephrolithotomy? Urol Int. 2005;75:322-6. DOI: https://doi.org/10.1159/000089167
  6. 6. Tena González Méndez G, García-Escobar JC, Jiménez-Cisneros E, et al. The role of laparoscopic surgery in the management of urinary lithiasis in the era of endourology in Mexico. Rev Mex Urolog 2024; 84:1-12. DOI: https://doi.org/10.48193/zc2x9531
  7. 7. Simforoosh N, Aminsharifi A. Laparoscopic management in stone disease. Curr Opin Urol. 2013; 23:169-74. DOI: https://doi.org/10.1097/MOU.0b013e32835d307f
  8. 8. Bayar G, Tanriverdi O, Taskiran M, et al. Comparison of laparoscopic and open ureterolithotomy in impacted and very large ureteral stones. Urol J. 2014; 11:1423-8.
  9. 9. Kijvikai K. The role of laparoscopic surgery for renal calculi management. Ther Adv Urol. 2011; 3:13-8. DOI: https://doi.org/10.1177/1756287211398254
  10. 10. Al-Hunayan A, Abdulhalim H, El-Bakry E, et al. Laparoscopic pyelolithotomy: is the retroperitoneal route a better approach? Int J Urol. 2009; 16:181-6. DOI: https://doi.org/10.1111/j.1442-2042.2008.02210.x
  11. 11. Zhang F, Gao S, Zhao Y, et al. Comparison of sutureless and conventional laparoscopic partial nephrectomy: a propensity score-matching analysis. Front Oncol. 2021; 11:649356. DOI: https://doi.org/10.3389/fonc.2021.649356
  12. 12. Abdel Raheem A, Alowidah I, Hagras A, et al. Laparoscopic ureterolithotomy for large proximal ureteric stones: Surgical technique, outcomes and literature review. Asian J Endosc Surg. 2021;14:241-9. DOI: https://doi.org/10.1111/ases.12861
  13. 13. Singh V, Sinha RJ, Gupta DK, et al. Transperitoneal versus retroperitoneal laparoscopic ureterolithotomy: a prospective randomized comparison study. J Urol. 2013;189:940-5. DOI: https://doi.org/10.1016/j.juro.2012.09.114
  14. 14. Hu H, Xu L, Wang S, et al. Ureteral stricture formation after removal of proximal ureteral stone: retroperitoneal laparoscopic ureterolithotomy versus ureteroscopy with holmium: YAG laser lithotripsy. PeerJ. 2017; 5:e3483. DOI: https://doi.org/10.7717/peerj.3483
  15. 15. Skrepetis K, Doumas K, Siafakas I, Lykourinas M. Laparoscopic versus open ureterolithotomy. A comparative study. Eur Urol. 2001;40:32-6. DOI: https://doi.org/10.1159/000049746
  16. 16. Garg M, Singh V, Sinha RJ, et al. Prospective randomized comparison of open versus transperitoneal laparoscopic ureterolithotomy: experience of a single center from Northern India. Curr Urol. 2013; 7:83-9. DOI: https://doi.org/10.1159/000356254
  17. 17. Khalil M, Omar R, Abdel-Baky S, Mohey A, Sebaey A. Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach? Turk J Urol. 2015; 41:185-90. DOI: https://doi.org/10.5152/tud.2015.03442
  18. 18. Bove P, Micali S, Miano R, et al. Laparoscopic ureterolithotomy: a comparison between the transperitoneal and the retroperitoneal approach during the learning curve. J Endourol. 2009; 23:953-7. DOI: https://doi.org/10.1089/end.2008.0055
  19. 19. Al-Sayyad A. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones. Urol Ann. 2012; 4:34-7. DOI: https://doi.org/10.4103/0974-7796.91619
  20. 20. Keeley FX, Gialas I, Pillai M, et al. Laparoscopic ureterolithotomy: the Edinburgh experience. BJU Int. 1999; 84:765-9. DOI: https://doi.org/10.1046/j.1464-410x.1999.00287.x
  21. 21. Nouira Y, Kallel Y, Binous MY, et al. Laparoscopic retroperitoneal ureterolithotomy: initial experience and review of literature. J Endourol. 2004; 18:557-61. DOI: https://doi.org/10.1089/end.2004.18.557
  22. 22. Feyaerts A, Rietbergen J, Navarra S, et al. Laparoscopic ureterolithotomy for ureteral calculi. Eur Urol. 2001; 40:609-13. DOI: https://doi.org/10.1159/000049845
  23. 23. El-Moula MG, Abdallah A, El-Anany F, et al. Laparoscopic ureterolithotomy: our experience with 74 cases. Int J Urol. 2008;15:593-7. DOI: https://doi.org/10.1111/j.1442-2042.2008.02065.x
  24. 24. Sahin S, Aras B, Eksi M, et al. Laparoscopic Ureterolithotomy. JSLS 2016;20:e2016.00004. DOI: https://doi.org/10.4293/JSLS.2016.00004
  25. 25. Ramalingam M, Murugesan A, Senthil K, Pai MG. A comparison of continuous and interrupted suturing in laparoscopic pyeloplasty. JSLS. 2014; 18:294-300. DOI: https://doi.org/10.4293/108680813X13753907291873
  26. 26. Tonyali S, Yilmaz M, Tzelves L, et al. Predictors of ureteral strictures after retrograde ureteroscopic treatment of impacted ureteral stones: a systematic literature review. J Clin Med. 2023;12:3603. DOI: https://doi.org/10.3390/jcm12103603
  27. 27. Aminsharifi A, Hosseini MM, Khakbaz A. Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for a solitary renal pelvis stone larger than 3 cm: a prospective cohort study. Urolithiasis. 2013; 41:493-7. DOI: https://doi.org/10.1007/s00240-013-0589-0
  28. 28. Darwish AE, Gadelmoula MM, Abdelkawi IF, et al. Ureteral stricture after ureteroscopy for stones: A prospective study for the incidence and risk factors. Urol Ann. 2019; 11:276-81. DOI: https://doi.org/10.4103/UA.UA_110_18
  29. 29. Basiri A, Tabibi A, Nouralizadeh A, et al. Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomizedclinical trial. Urol J. 2014; 11:1932-7.
  30. 30. Wang X, Li S, Liu T, et al. Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis. J Urol. 2013; 190:888-93. DOI: https://doi.org/10.1016/j.juro.2013.02.092

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2026 the Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.