Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study

Abstract

Background: Different treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid 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, postoperative 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 five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group. Conclusion: The stone-free rates after semirigid 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.

Laser Lithotripsy for the Management of Ureteric Calculus

“…Pain abdomen was the presenting complaint in a study done in India by Jagannath et al 9 In contrast to these, Jeevaraman et al 15 found hematuria as the most common clinical presentation of ureteric calculi. In our study, left ureteric calculus (49.2%) was more common which was similar to study done by Rashid et al 16 and Ali et al 17 Right ureteric calculi undergoing laser lithotripsy was slightly more common (60.7%, 50.3% and 51.4%) in studies done by Jagannath et al, 9 Abedi et al 4 and Koju et al 3 respectively. Bilateral calculi were only 7.6% in our study and this finding was similar to other studies.…”

“…Other studies show variation in the size of the calculus undergoing laser lithotripsy, the mean stone size ranging from 7.08 ± 1.66 mm to 14.44 ± 3.56 mm. 4,14,[16][17][18][19] Stone density also predict stone composition and different stones have different HU but success does not correlate with stone density. 20 The mean density of the calculus in our study was 1312.36 ± 324.37 and 87.3% patients had calculus with density ≥1000 HU.…”

Efficacy of intravenous hydration during extracorporeal shock wave lithotripsy in improving ureteral stone treatment success rate

“…This definition is similar to that used in previous studies. 7,8 The urologists were blinded to each other's clinical assessment and the application of intravenous hydration during the SWL.…”

“…Treatment success was defined as either complete freedom from lithiases or persistence of a residual stone <0.4 cm in diameter upon follow‐up plain abdominal radiography in the fourth week, after assessment by two individual urologists. This definition is similar to that used in previous studies 7,8 . The urologists were blinded to each other’s clinical assessment and the application of intravenous hydration during the SWL.…”

Integral criterion for estimation the effectiveness of lithotripsy-treated urolithiasis

“…В зарубежной литературе этот критерий носит название 'stone free rate' (SFR) [5,6]. На практике коэффициент эффективности Esfr колеблется в диапазоне 40,0 -95,0% [7].…”