Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience

Abstract

Objective: To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. Materials and Methods: This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients' characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. Results: It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. Conclusions: For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS. Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature.

Ureteroscopic Lithotripsy versus Laparoscopic Ureterolithotomy or Percutaneous Nephrolithotomy in the Management of Large Proximal Ureteral Stones: A Systematic Review and Meta-Analysis

“…Of the 14 included studies, 7 compared URS with LU [1,9,12] , 4 compared URS with PCNL [10,13,18,19], and 3 compared URS with LU or PCNL [6,8,11] . Among these 7 studies that compared URS with LU, 3 studies used the retrograde intrarenal surgery (RIRS) technique in the URS group comparing with LU [2,12,20] . In the URS vs. PCNL group, 2 studies used the mPCNL technique compared to RIRS [13,19] .…”

“…The mean size of stones ranged from 12 to 23 mm. Ten trials reported the presence of complications [2,7,[10][11][12][13][18][19][20][21] . The complication rate ranged from 4.1 to 33.8%.…”

“…Seven trials were RCTs [1, 7-9, 11, 12, 21] of which 6 were retrospective control studies [2,6,11,[18][19][20] and 1 was a prospective control study [13] . The remaining 8 were non-RCTs.…”

“…When referring to treatment methods of eliminating large proximal ureteral stones (diameter greater than 10 mm), the best modality is still a matter of controversy, especially when ESWL management fails. Flexible ureteroscopy with laser lithotripsy having a high surgical success rate has been popularized in recent years, but this procedure necessitates the use of special devices that are not available in all hospitals [2] . PCNL is considered as method of treatment mainly for patients with a large stone burden and proximal ureteral stones, but it is more associated with a higher complication rate [6] .…”

Taş Hastalığında Açık ve Laparoskopik Cerrahinin Yeri Var Mı?

“…Neto ve ark. 'ları, prospektif çalışmalarında 1 cm'den büyük taşı olan hastalarda SWL, LU ve URS'yi karşılaştırmışlar ve laparoskopi grubunda taşsızlık oranını (%93) URS (%62) ve SWL (%35)'ye göre daha yüksek olarak saptamışlardır (57,58).…”