Laparoscopic ureterolithotomy for a large 2.5cm proximal ureteral stone. After mobilization of the colon, identification of the ureter and dissection of the inflammatory region when the stone is impacted. Opening of ureter using cold cut in order to obtain a neat incision and prevent thermal damage to the ureter.
When a ureteral stone needs surgery
Most ureteral stones either pass on their own or are treated with shockwave lithotripsy or ureteroscopy. A 2.5 cm stone in the upper ureter is a different problem: it is far too large to pass, and in this case it had become impacted, with inflammatory tissue forming around it. Laparoscopic ureterolithotomy, opening the ureter directly and lifting the stone out intact, is often the most reliable way to clear a stone of this size in one procedure.
Why the ureter is opened with a cold cut
The ureter is a narrow muscular tube with a delicate blood supply. Opening it with electrocautery risks thermal injury to the wall, which can heal as a stricture and cause obstruction months later. Cutting with a cold blade produces clean edges that close reliably. The ureter is then repaired and usually stented so that it heals without narrowing.
What happens afterwards
A stent is normally left in place for a few weeks and removed in a short outpatient procedure. Because the stone is retrieved whole it can be sent for compositional analysis, which is genuinely useful: knowing what the stone is made of guides how to prevent the next one. Anyone who has formed a stone this large should have a metabolic assessment rather than simply having the episode treated.