LAPAROSCOPIC URETEROLITHOTOMY VERSUS LASER LITHOTRIPSY IN MANAGEMENT OF UPPER URETERIC STONES

Abstract

Background: The optimal treatment for ureteral calculi must consider many factors, including stone composition, location and size, patient characteristics, technical skills of the surgeon, and instrument availability. Aim of the Work: To assess the result of ureteroscopic lithotripsy using holmium laser with laproscopic ureterolithotomy in the management of proximal ureteral stones larger than 10mm. Patients and Methods: 80 patients with unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy (n=40), and another group underwent laparoscopic ureterolithotomy (n=40). Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. Results: Operation was successfully performed in all 80 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 33.83 ± 6.39 min and 107.25 ± 20.13 min, respectively, their hospitalization time was 1.65 ± 0.48 days vs. 3.90 ± 0.63days, and stone clearance rate was 880.0% (32/40) vs. 95% (38/40), and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL). All patients were followed up for more than three months, and no seriouscomplications such as ureterostenosis occurred. Conclusion: Laparoscopic ureterolithotomy and Ureteroscopy are both effective and reliable for the treatment of proximal ureteral stones. However, considering the shorter operation andhospitalization times we suggest that ureteroscopy, as a minimally invasive method, may be the first choice in the treatment of proximal ureteral stones.