Comparative study of different modalities of treatment for large upper ureteric calculi

Abstract

Background: Urolithiasis is one of the most common urological diseases and has become a worldwide health problem. Minimally invasive therapies such as extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, RIRS and laparoscopic surgery have revolutionized the treatment of ureteric calculi, altering surgical treatment dramatically.Methods: It was a prospective randomized study conducted between March 2012 to March 2017. 60 patients with large upper ureteric calculi of >15 mm in size were randomly selected for the study. Diagnosis was made using ultrasonography, plain X-ray KUB, IVU and spiral CT KUB. Patients were divided randomly into 4 groups of 15 patients each. Routine post-op X-ray KUB and USG were done for all the patients. All the data was recorded and analysed.Results: LAP group had the highest stone clearance rate (100%) in our study. The difference in stone clearance rate was statistically significant when compared with ESWL (73.33%) and URS group (66.7%), whereas no statistical significance was found between LAP and PCNL group (93.33%). URS group in our study had highest intra-operative complications (33.33%) and laparoscopic group had least number of complications. Post-procedural complications occurred in 1 patient (6.7%) in URS group, 2 patients in ESWL group (13.3%) and 1patient each in LAP and PCNL group (6.7%).Conclusions: Laparoscopic ureterolithotomy is a feasible and effective method of treating large (>15 mm) upper ureteric calculus. It is associated with least intra-operative complications and semirigid ureteroscopy has highest intra-operative complications.