Laparoscopic Ureterolithotomy vs Ureteroscopic Lithotripsy for Large Ureteral Stones

Abstract

Background and Objectives: The purpose of this study was to compare two methods (transperitoneal laparoscopic ureterolithotomy [TLU] and a combination of ureteroscopic lithotripsy [UL] with retrograde intrarenal surgery [RIRS]) designed for the treatment of large proximal ureteral calculi so that their associated complications and stone-free rates could be assessed. Methods: A total of 100 patients from three different hospitals who were diagnosed with large upper ureteral stones (≥15 mm) were treated via TLU (n = 48) or UL-RIRS (n = 52). They were treated between March 2012 and May 2014. The study compared the complications, success rate, patient characteristics, and the operation time between the two groups. Results: The immediate stone clearance rate after a single session was higher in the TLU group than in the UL-RIRS group (100% vs 73.1%, P = .005). However, there was no significant difference in the stone-free rates between the two groups three months after the last procedure was performed (100% vs 96.1%, P = .655). Regarding patients with a history of early-failure extracorporeal shock-wave lithotripsy, there was no significant difference in the stone-free rate between the two groups three months after the last procedure (100% vs 94.4%, P > .05). Further, overall complication rates between the groups were not statistically different ( P = .261). Conclusion: This study demonstrates that TLU is an effective and safe procedure to treat large impacted upper ureteral stones. When compared to UL-RIRS, TLU showed equivalent efficacy and safety, though there were failed first-line treatments.

Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis

“…Overall, 25 studies including 2.888 patients were included in this network meta-analysis ( Figure- There were sixteen RCT studies (13-16, 21-26, 29, 31, 33-36) and nine non-RCT studies (12, 17-20, 27, 28, 30, 32) included in this study ( Table-1). Twenty three studies reported URSL, making it the most commonly used treatment (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(33)(34)(35)(36). Thirteen studies reported LU (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), twelve studies reported ESWL (21-21, 33, 34), and six studies reported PCNL (22,23,31,32,35,36).…”

“…Twenty one studies reported auxiliary procedures (12-15, 17-27, 29, 30, 32, 33, 35, 36). Twenty three studies reported Clavien Dindo score ≥3 complications (12,13,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Eleven studies reported fever (12, 13, 22, 26-28, 30-32, 34, 36).…”

“…There were sixteen RCT studies ( 13 - 16 , 21 - 26 , 29 , 31 , 33 - 36 ) and nine non-RCT studies ( 12 , 17 - 20 , 27 , 28 , 30 , 32 ) included in this study ( Table-1 ). Twenty three studies reported URSL, making it the most commonly used treatment ( 12 - 30 , 33 - 36 ).…”

“…Twenty four studies reported initial stone-free rate ( 12 - 14 , 16 - 36 ). Twelve studies reported final stone-free rate ( 12 , 19 - 27 , 33 , 35 ). Twenty one studies reported auxiliary procedures ( 12 - 15 , 17 - 27 , 29 , 30 , 32 , 33 , 35 , 36 ).…”

“…In this network meta-analysis, three studies reported URSL-RIRS (27,30,34). Because some of the patients received URSL, other patients with stone retropulsion received RIRS.…”