Semi-rigid Ureteroscopy versus Open Ureterolithotomy for Management of Large Upper Ureteric Stones: a Comparative Study

Objectives: To compare outcome of open ureterolithotomy versus semi-rigid ureteroscopy in management of large upper ureteric stones. Patients and Methods: Patients with large upper ureteric stones (≥2cm) who were managed by ureteroscopy (31 patients) or ureterolithotomy (31 patients) were included retrospectively from January 2012 to December 2014. Primary stone-free rate (SFR), secondary SFR (after auxiliary and retreatment procedures) and complications were compared between both groups. Efficiency quotient was calculated. Comparison of study groups was done using Chi-square, Fisher-exact, independent-T or Mann–Whitney tests as appropriate. Results: Most of stones were impacted. There was no significant difference in age, gender, creatinine, side and radiolucency of stones. Median stone surface area was 2.85cm and 2.94cm in ureteroscopy and ureterolithotomy groups; respectively. Operative time and hospital stay were significantly longer in ureterolithotomy (p<0.001). There was no significant difference in complications between both groups (p=0.576). SFR after first session was 100% after ureterolithotomy and 71% after ureteroscopy (p=0.002). Ureteroscopy Failure was caused by migration of fragments (12.9%), residual fragments (12.9%) and inability to reach stones (3.2%). Auxiliary and retreatment rates were significantly more with ureteroscopy (22.6%) (p=0.011). Secondary SFR in ureteroscopy group improved to 96.8%. Efficiency quotient was 78% for ureteroscopy and 100% for ureterolithotomy. Conclusion: Open ureterolithotomy may be considered a viable option for treatment of large upper ureteric stones (>2cm) especially in situations where the lack of minimally invasive alternatives or their cost are prohibitive. Open ureterolithotomy has the highest success in a single session with the best treatment efficiency. Key-words: Complications; treatment outcome, upper ureteric stones, ureterolithotomy, ureteroscopy.