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Randomized Controlled Trial
. 2024 Nov;134(5):747-754.
doi: 10.1111/bju.16494. Epub 2024 Jul 31.

Ureteroscopy vs laparoscopic ureterolithotomy for large proximal ureteric stone: a randomised trial

Fabio C M Torricelli  1 , Victor Srougi  1 , Giovanni S Marchini  1 , Fabio C Vicentini  1 , Carlos A Batagello  1 , Alexandre Danilovic  1 , Marco A Arap  1 , Hiury Andrade  1 , Anuar I Mitre  1 , Ricardo D Jordão  1 , Manoj Monga  2 , William C Nahas  1 , Eduardo Mazzucchi  1
Affiliations
Randomized Controlled Trial

Ureteroscopy vs laparoscopic ureterolithotomy for large proximal ureteric stone: a randomised trial

Fabio C M Torricelli et al. BJU Int. 2024 Nov.

Abstract

Objective: To compare the outcomes of retrograde flexible ureteroscopy (fURS) with retroperitoneal laparoscopic ureterolithotomy (RLU) for large proximal ureteric stones.

Patients and methods: A prospective randomised trial was conducted from January 2018 through December 2022 including patients with impacted proximal ureteric stones of 15-25 mm. Patients underwent fURS or RLU. Primary outcome was the stone-free rate. Demographic data, stone features, and complications rates were also compared between groups.

Results: A total of 64 patients were enrolled, 32 in each group. The mean impacted stone time was similar between groups, as well as stone size (17 mm) and stone density (>1000 Hounsfield Units). The ureteric stone-free rates between the two groups (93.7% in fURS vs 96.8% in RLU; odds ratio [OR] 0.72, 95% confidence interval [CI] -1.72 to 3.17; P = 0.554), and overall success rates, which take into account residual fragments in the kidney (84.3% in fURS vs 93.7% in RLU; OR 1.02, 95% CI -0.69 to 2.74; P = 0.23), were similar. Operative time was also not statistically significantly different between groups (median 80 vs 82 min; P = 0.101). There was no difference in hospital length of stay. Retropulsion rate was higher with fURS (65.6% vs 3.1%; p < 0.001). Residual hydronephrosis (34.3% each group) and complication rates did no differ according to treatment.

Conclusion: Flexible URS and RLU are both highly efficient and present low morbidity for large impacted proximal ureteric stone treatment. RLU is not superior to fURS.

Keywords: hydronephroses; kidney; lithotripsy; ureter; urinary calculi.

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References

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