Efficacy and Safety of Treatment Options for Large Upper Ureteral Stone

Authors

  • Imtiaz Enayetullah Assistant Professor, Department of Urology, NIKDU, Dhaka.
  • Md Asaduzzaman Rajib Assistant Registrar Department of Urology, NIKDU, Dhaka.
  • Mohammad Mahfuzur Rahman Assistant Registrar, Department of Urology, NIKDU, Dhaka.
  • Ashraf Rahman Assistant Registrar, Department of Urology, NIKDU, Dhaka.
  • Sharif Md Shahadat Ali Khan Medical Officer, Department of Urology, NIKDU, Dhaka.
  • Md Faisal Islam Associate Professor, Department of Urology, NIKDU, Dhaka.

DOI:

https://doi.org/10.3329/bju.v25i2.68588

Keywords:

Ureteral calculi, Ureteroscopy, Percutaneous, Nephrolithotomy, Laparoscopy.

Abstract

Background: There are three minimally invasive methods for the treatment of large (>1 cm) upper ureteral stones: ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LUL). With multiple surgical options, the controversy of choosing the best option for a given patient lies.

Objective: To compare efficacy and safety between URSL, PCNL and LUL to determine the best choice.

Methodology: This study was conducted from March 2020 to February 2022 with 120 patients who had upper ureteral stones admitted at NIKDU. They were randomized into 3 equal URSL, PCNL & LUL groups, 40 patients in each group. The primary outcome was a stone-free rate after 1 month of surgery, and the secondary outcomes were the duration of surgery, length of hospital stay, and complication rate postoperatively.

Result: Eight patients needed auxiliary PCNL after URSL and 1 patient after LUL, but none after PCNL. The stone-free rate was 78.1% (25/32) in the URSL group, 95% (38/ 40) in the PCNL group and 100% (39/39) in the LUL group. Operation time was the shortest with URSL and the longest with LUL (all p <0.05). Hospital stay was shorter in the URSL group compared with PCNL & LUL group (p=0.0001). Operation-related complications were almost similar among the three groups.

Conclusion: Laparoscopic ureterolithotomy followed by PCNL is the most efficacious modality for treating large upper ureteral stones with a superior stone-free rate and lesser need for auxiliary treatments compared to URSL.

Bangladesh J. Urol. 2022; 25(2): 93-97

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Published

2023-10-10

How to Cite

Enayetullah, I. ., Rajib, M. A. ., Rahman, M. M. ., Rahman, A. ., Khan, S. M. S. A. ., & Islam, M. F. . (2023). Efficacy and Safety of Treatment Options for Large Upper Ureteral Stone. Bangladesh Journal of Urology, 25(2), 93–97. https://doi.org/10.3329/bju.v25i2.68588

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Section

Original Articles