Objective: To compare the stone free rate and post-operative outcomes between semi-rigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones.
Patient and methods: Sixty- seven patients with a solitary upper ureteral stone who had LU or semi-rigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had Semi-rigid ureteroscopy and holmium laser lithotripsy (group A) and 30 patients had laparoscopic ureterolithotomy (group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, post-operative complications and stone free rate.
Results: The mean stone size was 1.84 ± 0.12 cm in Group (A) and 1.79 ± 0.17 cm in Group (B) P value = 0.2 . The mean operative time was 61.5 ± 3.5 min in Group (A) and 63± 4.2 min in Group (B), P value= 0.13. Stone migration was recorded in 5 cases (14%) in Group (A) while no cases in Group (B) had stone migration. Flexible ureteroscope was used as an auxiliary measure in 5 patients (14%) in Group (A) at the same session. No auxiliary measures were used in the LU group.
Conclusion: The stone-free rates after semi-rigid URS and laser lithotripsy are comparable to those following LU especially when flexible URS is used to manage migrating stone fragments at the same session.
Keywords: Ureteroscopy, laparoscopy, lithotripsy, laser, upper ureter, stone, free rate.
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