PNEUMATIC URETEROSCOPIC LITHOTRIPSY VERSUS LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE UPPER URETERAL STONES- AN INITIAL EXPERIENCE.

Abstract

Objective: The treatment of choice for large upper ureteral stones is controversial. In the developing nations, semi rigid ureteroscopy is the preferred treatment modality for ureteric stones even in upper ureter. However, Laparoscopic ureterolithotomy has started gaining acceptance for the treatment of large proximal ureteral stones. This study was done to compare solely the outcomes of semi-rigid pneumatic ureterolithotripsy (URSL) and transperitoneal laparoscopic ureterolithotomy (LU) for large upper ureteric stones. Methods: In all, 30 patients who met the inclusion criteria were randomised into 2 groups: URSLand LU. The groups were compared for stone clearance rate, operative time, complication rates.Results: LU had signicantly higher stone clearance rate both at discharge (p=0.014) and at 3 weeks post operatively (p = 0.033) than URSL. On the other hand, URSLhad signicantly shorter mean operating time (p<0.0001), length of hospital stay (p=0.0013) and required less auxiliary procedures than LU group. No major complications were observed and the complication rate was not statistically signicant among the groups (p=0.41).Conclusion: Laparoscopic ureterolithotomy was associated with higher stone clearance rate but with longer hospital stay and operative time than URSL, however the complications were similar. Consequently, the procedure of choice for large proximal ureteric calculi should be based on the expertise of the surgeon, patient's choice and the availability of equipments.