Open Ureterolithotomy
Direct surgical stone removal from the ureter through a small incision — reserved for very large impacted stones or failed endoscopy, with near-100% single-session clearance.
What is Open Ureterolithotomy?
Open Ureterolithotomy is a surgical procedure in which a direct incision is made in the flank or lower abdomen to expose the ureter and remove an impacted stone under direct vision. While endoscopic techniques have replaced it in most cases, open ureterolithotomy remains important for very large impacted stones, failed endoscopic attempts, concomitant ureteric pathology requiring open repair, or settings where advanced endoscopic equipment is unavailable. It provides near-100% stone-free rates in a single definitive procedure with a well-established safety profile.
How the Procedure Works
Incision Planning
Incision chosen based on stone location; retroperitoneal space entered through flank or Gibson approach without entering the peritoneal cavity.
Ureter Exposure
Ureter identified in retroperitoneal fat, dissected from surrounding structures, and controlled with slings above and below the stone.
Ureterotomy
Longitudinal incision made directly over the stone; stone carefully delivered intact using fine forceps, preserving the ureteric wall.
Ureteric Inspection
Ureter inspected above and below the stone site; on-table flexible ureteroscope confirms clearance distally and proximally.
Closure & Drainage
Ureterotomy closed with interrupted absorbable sutures; DJ stent placed; retroperitoneal drain inserted; wound closed in anatomical layers.
Outcomes
Who Needs This Treatment?
- →Patients with very large impacted ureteric stones that have not fragmented despite multiple endoscopic attempts.
- →Those with concomitant ureteric stricture requiring simultaneous open repair at the time of stone removal.
- →Patients in healthcare settings where advanced flexible ureteroscopy or holmium laser is unavailable.
- →Anyone who needs a single definitive stone removal with the highest possible certainty of complete clearance.
- →Patients with complex ureteric anatomy from prior surgery, radiation, or congenital anomalies making endoscopy hazardous.
- →Those with complete obstruction from a very large stone causing impending renal failure requiring urgent decompression.
"While we prefer minimally invasive techniques, open ureterolithotomy has a definite role in complex stone cases. It provides unmatched stone-free rates when endoscopy is not feasible — and an experienced urologist must always be prepared to offer it."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
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