Retrograde, Antegrade, and Laparoscopic Approaches for the Management of Large, Proximal Ureteral Stones: A Randomized Clinical Trial
- 1 December 2008
- journal article
- research article
- Published by Mary Ann Liebert Inc in Journal of Endourology
- Vol. 22 (12), 2677-2680
- https://doi.org/10.1089/end.2008.0095
Abstract
Multiple procedures have been introduced for the management of urinary stones in the upper ureter. In this randomized clinical trial, we compared three surgical options in this regard. From September 2004 to May 2006, we enrolled in the study 150 patients with upper ureteral stones who were referred to our center. We included patients with a stone size >or= 1.5 cm in the greatest diameter. Using the random table, patients were divided into three 50-patient groups by treatment: Group A, retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; group B, transperitoneal laparoscopic ureterolithotomy; and group C, percutaneous nephrolithotripsy. All procedures were performed in a training program. The stone-free rates for patients in groups A, B, and C, at discharge and 3 weeks later, were 56%, 88% and 64% and 76%, 90% and 86%, respectively. Conversion to open surgery and repeated laparoscopy was necessary for two and one patients in group B. Urinary leakage continued more than 3 days in eight (16%) and nine (18%) patients in groups B and C after operation, respectively (P = 0.7). Although the success rate of ureteroscopy was not significantly lower than the two other options, the complications seen with this technique were negligible. Consequently, the procedure of choice for large proximal ureteral stones seems to depend on surgeon expertise and availability of equipment.Keywords
This publication has 14 references indexed in Scilit:
- Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stonesUrology, 2006
- Retroperitoneal Laparoscopic Ureterolithotomy for Upper Ureter StonesJournal of Korean Medical Science, 2006
- Holmium:YAG Lasertripsy with Semirigid Ureterorenoscope for Upper-Ureteral Stones >2 cmJournal of Endourology, 2005
- Does Failure to Visualize the Ureter Distal to an Impacted Calculus Constitute an Impediment to Successful Lithotripsy?Journal of Endourology, 2004
- Prediction of Fragility of Urinary Calculi by Dual X-Ray AbsorptiometryJournal of Urology, 2003
- Benefits of Ureteroscopic Pneumatic Lithotripsy for the Treatment of Impacted Ureteral StonesJournal of Endourology, 2001
- URETERAL STONES CLINICAL GUIDELINES PANEL SUMMARY REPORT ON THE MANAGEMENT OF URETERAL CALCULIJournal of Urology, 1997
- Laparoscopic Treatment of an Upper Ureteral StoneJournal of Laparoendoscopic Surgery, 1993
- Minimally Invasive Treatment of Ureteric Calculi Using Modern TechniquesBJU International, 1990