Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis.

Selcuk Sahin,Mithat Eksi,Arda Atar,Berkan Resorlu,Bekir Aras,Volkan Tugcu

doi:10.12669/pjms.323.9938

Abstract

Objective:To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones.Methods:A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group.Results:It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001).Conclusions:The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities.

Highlights

Various studies in the literature have investigated the success of shock wave lithotripsy (SWL), URS and laparoscopic ureterolithotomy in the treatment of large proximal ureteral stones.[7,8,9]
There was no significant difference between the groups of patients for age, gender, stone size, stone density and stone site; there was a significant difference for body mass index (BMI)
Our study showed that the stone-free rate was significantly greater in the transperitoneal laparoscopic ureterolithotomy (TPLU) group (100%) as compared to the flexible ureteroscopy (F-URS) (80%) group, which indicated TPLU was a perfect option for proximal ureteral stones

Summary

Introduction

Urosepsis due to ureteral obstruction by stone impaction is a life-threatining condition which usually require urgent drainage of the Correspondence: February 8, 2016 February 12, 2016 April 12, 2016 collecting system.[1,2] Emergent collecting system decompression with percutaneous nephrostomy tube or double-J stent and proper antibiotic therapy are the essential steps of the treatment before stone surgery.[3,4,5,6,7] After the initial treatment, available techniques include shock wave lithotripsy (SWL), ureteroscopy (URS) using flexible or semirigid devices, laparoscopic ureterolithotomy and open surgery.The most popular techniques are SWL and URS for the treatment of upper ureteral calculi less than 1 cm in size, because of low morbidity and acceptable efficacy of these methods. Urosepsis due to ureteral obstruction by stone impaction is a life-threatining condition which usually require urgent drainage of the Correspondence: February 8, 2016 February 12, 2016 April 12, 2016 collecting system.[1,2] Emergent collecting system decompression with percutaneous nephrostomy tube or double-J stent and proper antibiotic therapy are the essential steps of the treatment before stone surgery.[3,4,5,6,7] After the initial treatment, available techniques include shock wave lithotripsy (SWL), ureteroscopy (URS) using flexible or semirigid devices, laparoscopic ureterolithotomy and open surgery. Various studies in the literature have investigated the success of SWL, URS and laparoscopic ureterolithotomy in the treatment of large proximal ureteral stones.[7,8,9] But the best treatment option is still controversial, and to the best of our knowledge those techniques have not been compared in cases of obstructive pyelonephritis

Methods

Results

Conclusion