Abstract
Background: The technical advancements in urology have profoundly changed the management of upper ureteric calculus. The present study compared antegrade percutaneous versus retrograde ureteroscopic lithotripsy in upper ureteric cases. Subjects and Methods: The present study was conducted at NRI Medical College & Hospital, Chinakakani, Mangalagiri Mandal, Andhra Pradesh from May 2013 to April 2014 on 60 patients with upper ureteric stones of both genders. Patients were divided into 2 groups. Group I patients were treated with antegrade percutaneous and group II with retrograde ureterolithotripsy. Outcome in both groups was recorded and compared. Results: The mean anesthetic time in group I was 82.4 minutes and in group II was 73.1 minutes, operative time was 45.2 minutes in group I and 58.4 minutes in group II, post- operative stay in group I was 2.6 days and in group II was 1.7 days, stone clearance was seen in 26 patients in group I and 22 in group II. Mean stone size in group I was 1.89 cm and in group II was 1.49 cm. Follow ups days were 71.2 in group I and 83.4 in group II. Clavien-Dindo categorization grade 0 was seen in 16 in group I and 13 in group II, grade 1 in 10 in group I and 12 in group II and grade 2 in 4 in group I and 5 in group II. The difference was significant (P< 0.05). There were 4 and 5 patients in group I and group II with post- operative complications (P< 0.05). Conclusion: Authors found that antegrade percutaneous has better stone clearance rates as compared to retrograde ureterolithotripsy for an upper ureteric calculus.
Highlights
Large proximal ureteral stones can lead to urinary obstruction, which may be followed with renal function injury and life-threatening sepsis
Group I patients were treated with antegrade percutaneous technique and group II with retrograde ureterolithotripsy
[Table 1] shows that group I patients were treated with antegrade percutaneous and group II with retrograde ureterolithotripsy
Summary
Large proximal ureteral stones can lead to urinary obstruction, which may be followed with renal function injury and life-threatening sepsis. [1] Timely intervention to remove the stones completely is of great importance while the most appropriate treatment remains controversial. According to the latest American Urological Association (AUA) Guideline on surgical management of stones, extracorporeal shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) have been proposed as the first-line treatments for proximal ureteral stone. Before the introduction of shock wave lithotripsy (SWL) in 1980, open ureterolithotomy or basket extraction of stones under fluoroscopic guidance was the mainstay of treatment. The blind basket extraction technique is obsolete, and open ureterolithotomy has been replaced by laparoscopic ureterolithotomy which is limited to a few indications such as a large, impacted calculus not amenable to SWL or endoscopic procedures. Extracorporeal shock wave lithotripsy (SWL) represents a valuable option, retrograde ureteroscopic lithotripsy (URSL) and antegrade PCNL are both recommended as first-line treatment option according to most recent guidelines. Prasad & Prasad: Antegrade Percutaneous Versus Retrograde Ureteroscopic Lithotripsy retrograde ureteroscopic lithotripsy in upper ureteric cases
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