MP29-01: Comparison of Transperitoneal Laparoscopic Ureterolithotomy, Retrograde Flexible Ureteroscopy, and Mini- percutaneous Antegrade Ureteroscopic Lithotripsy in the Management of Large Proximal Ureteral Stones (1.5-2 cm): A Prospective Randomized Tri
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Ahmed Zoeir*, Talaat Zaghloul, Hussein mamdoh, Ayman Mousa, tarek Gameel, Hasan ElTatawy, Maged Ragab, Mohamed Abo-Elenein, Tanta, Egypt
Introduction
The optimal treatment for large proximal ureteric stones represents a dilemma. Different modalities have been described for treating such stones, including extracorporeal shock wave lithotripsy (ESWL), retrograde ureteroscopy (R-URS), percutaneous antegrade ureteroscopy (A-URS), laparoscopic ureterolithotomy (LUL), and rarely open ureterolithotomy. We aimed to compare the outcomes of transperitoneal LUL, R-URS, and A-URS for the management of such stones (15–20 mm).
Methods
After the approval of ethical committee, 105 patients with large proximal ureteric stones (15–20 mm) were randomized into three equal groups: Group A (35) patients underwent transperitoneal LUL, Group B (35) patients underwent R-URS, and Group C (35) patients underwent A-URS. In this study we used single use flexible URS ((WiScope Single-Use Digital, OTU Medical, USA) and Holmium laser ((Lumenis™ VersaPulse™ Holmium Laser 100 W). Demographic data, intraoperative, and postoperative data and complications were compared between the 3 groups.
Results
The mean age of the patients was 41.37 ± 8.70, 39.89 ± 8.29, and 40.31 ± 7.51 years in groups A, B, and C, respectively.The initial stone-free rate was significantly higher in group A (100%) compared to group B (74.3%) and group C (80%). The auxiliary procedures were required in nine patients (25.7 %) in group B vs. six patients (17.1%) in group C. Final SFRs were 100%, 80%, and 91.4% in groups A, B and C, respectively. The mean operative time was significantly shorter in group B (61.0 ± 8.21 minutes) vs. (76.0 ± 4.97 minutes) in group C and (85.0 ± 7.57 minutes) in group A. The post-operative complications were comparable in the 3 groups.
Conclusions
However, R-URS is less invasive; it is associated with a lower SFR and a higher rate of auxiliary procedures. Because of its invasiveness, longer OT and hospital stay, and higher risk of radiation exposure, the use of miniperc antegrade technique should be limited to selected cases such as; concurrent renal stones and/or cases of failed retrograde access. T-LUL is associated with the highest stone clearance rate and the lowest rate of auxiliary procedures needed; therefore, it is a valuable alternative if there is a lack of flexible endoscopes, instruments, and laser machines, particularly in hands with good experience in the laparoscopy field.
Source Of Funding
none
Author Block
Ahmed Zoeir*, Talaat Zaghloul, Hussein mamdoh, Ayman Mousa, tarek Gameel, Hasan ElTatawy, Maged Ragab, Mohamed Abo-Elenein, Tanta, Egypt
Introduction
The optimal treatment for large proximal ureteric stones represents a dilemma. Different modalities have been described for treating such stones, including extracorporeal shock wave lithotripsy (ESWL), retrograde ureteroscopy (R-URS), percutaneous antegrade ureteroscopy (A-URS), laparoscopic ureterolithotomy (LUL), and rarely open ureterolithotomy. We aimed to compare the outcomes of transperitoneal LUL, R-URS, and A-URS for the management of such stones (15–20 mm).
Methods
After the approval of ethical committee, 105 patients with large proximal ureteric stones (15–20 mm) were randomized into three equal groups: Group A (35) patients underwent transperitoneal LUL, Group B (35) patients underwent R-URS, and Group C (35) patients underwent A-URS. In this study we used single use flexible URS ((WiScope Single-Use Digital, OTU Medical, USA) and Holmium laser ((Lumenis™ VersaPulse™ Holmium Laser 100 W). Demographic data, intraoperative, and postoperative data and complications were compared between the 3 groups.
Results
The mean age of the patients was 41.37 ± 8.70, 39.89 ± 8.29, and 40.31 ± 7.51 years in groups A, B, and C, respectively.The initial stone-free rate was significantly higher in group A (100%) compared to group B (74.3%) and group C (80%). The auxiliary procedures were required in nine patients (25.7 %) in group B vs. six patients (17.1%) in group C. Final SFRs were 100%, 80%, and 91.4% in groups A, B and C, respectively. The mean operative time was significantly shorter in group B (61.0 ± 8.21 minutes) vs. (76.0 ± 4.97 minutes) in group C and (85.0 ± 7.57 minutes) in group A. The post-operative complications were comparable in the 3 groups.
Conclusions
However, R-URS is less invasive; it is associated with a lower SFR and a higher rate of auxiliary procedures. Because of its invasiveness, longer OT and hospital stay, and higher risk of radiation exposure, the use of miniperc antegrade technique should be limited to selected cases such as; concurrent renal stones and/or cases of failed retrograde access. T-LUL is associated with the highest stone clearance rate and the lowest rate of auxiliary procedures needed; therefore, it is a valuable alternative if there is a lack of flexible endoscopes, instruments, and laser machines, particularly in hands with good experience in the laparoscopy field.
Source Of Funding
none