Supine percutaneous nephrolithotomy in impacted proximal ureteral stones larger than 15 millimeters; Comparison of flexible ureterorenoscopy and retroperitoneal laparoscopic ureterolithotomy

Abstract

Objective: We aimed to compare the efficacy and safety of supine mini-percutaneous nephrolithotomy (SMPCNL), retroperitoneal laparoscopic ureterolithotomy (RPUL), and flexible ureterorenoscopy (FURS) in the treatment of impacted proximal ureteral stones larger than 15 mm in diameter.Material and Methods: Data of the patients who underwent SMPCNL, RPUL, and FURS in our institution for proximal ureteral stones between August 2015 and September 2020 were reviewed. Collected data included age, gender, body mass index (BMI) and hydronephrosis grade, stone density, duration of surgery, hospital stay and recovery period, stone-free and demographic data such as complication rates and duration of surgery.Results: Overall, 162 patients were included. Of these patients, 52 (32.1%) were in Group 1 (SMPCNL group), 53 (32.7%) were in Group 2 (RPUL group), and 57 (35.2%) ) were in Group 3 (FURS group). Mean operative times were 53±8.2 minutes in Group 1, 63.2±6.6 minutes in Group 2, and 73.7±7.5 minutes in Group 3 (p=0.000). The mean hospital stay was significantly shorter in Group 3 compared to the other groups (p=0.000). The stone-free rates at the initial evaluation were 100%, 90.3%, and 87.7% in the RPUL, SMPCNL, and FURS groups. This rate was significantly lower in the FURS group compared to the other groups (p=0.02).Conclusion: SMPCNL and RPUL procedures are as safe as FURS in treating patients with proximal ureteral stones larger than 15 mm.