Laparoscopic Ureterolithotomy Versus Ureteroscopy In Management Of Upper Ureteral Stone Larger Than 15 Mm In Adults

Abstract

Background: There are multiple approaches for treatment of patients with upper ureteral stones. Extracorporeal shockwave lithotripsy (SWL), ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL), laparoscopic ureterolithotomy (LU) and open ureterolithotomy each has advantages and disadvantages. Although SWL is minimally invasive and can be performed as an outpatient procedure, disadvantages include a high retreatment rate, long treatment time, and inability to dissect a large or impacted stone. Objective: The aim of this study was to compare between laparoscopic ureterolithotomy and retrograde ureteroscopy for treatment of large upper ureteric stones as regard operative time, blood loss, hospital stay, post-operative pain, use of analgesia, intraoperative & postoperative complications and success rate. Conclusion: LU provides a higher stone-free rate than URS in the management of large proximal ureteral stones. There are no differences regarding overall post-operative complications or major postoperative complications between the procedures. Semirigid URS is associated with a short operative time and length of hospital stay; however it leads to a higher need for auxiliary procedures. When counseling a patient with a large proximal ureteral stone, LU should be advised as the procedure with the higher chance of stone removal, although it is also more invasive, leading to longer operative time and length of hospital stay. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.