WCE 2018: Comparison Between Laparoscopic Ureterolithotomy and Ureteroscopic Lithotripsy for Proximal Ureteric Stones More than 15mm in Size

Paris, France (UroToday.com) Among the management strategies for urinary tract stones, ureteroscopic lithotripsy remains one of the most commonly used procedures. However, its effectiveness decreases with increasing stone size, especially for stones in the proximal ureter. Laparoscopic ureterolithotomy is considered a viable therapy for large, impacted ureteral stones that are not amenable to treatment with ureteroscopic lithotripsy, but is considered a much more invasive technique. In this study, Hong et al. attempts to examine the outcomes of these two strategies from a cost-benefit analysis perspective.

Eighty-nine patients who underwent ureteroscopic lithotripsy were respectively compared to 22 laparoscopic ureterolithotomy patients on the variables of length of hospital stay (LOS), stone clearance rate, perioperative complications and number of additional procedures. Retrospective analysis showed that operating time was significantly longer for uereterolithotomy (233 min) than for ureteroscopy (101 min) (p  < .05). The ureterolithotomy arm also had a longer hospital stay (3.8 days vs 1.6 days, p<0.05). In terms of stone clearance rate the ureteroscopy arm experienced a 60.98% rate vs. 90.91% for ureterolithotomy (p<0.05). In general, the complications rates were higher for the laparoscopy, but the number of additional procedures following treatment were lower than the ureteroscopy arm.

This retrospective study sheds some light on the factors that must be weighed when deciding on appropriate management for stone disease. While ureterolithotomy has advantages in terms of providing a favorable stone clearance rate and decreased follow up procedures, it is a more time intensive and costly procedure and has higher complication rates, most likely due to its generally more invasive nature. This points to the idea that treatment should be individualized based on the patient, and a shared decision-making process should be implemented when determining management strategies.

Presented by: Seok kwan Hong, MD, Senior Resident Tan Tock Seng Hospital 
Co-Authors: Yufei Qiao, Medical Officer, Tan Tock Seng Hospital, Clarissa Gurbani, MBChB, MRCS (UK), Medical Officer, Department of Urology, Tan Tock Seng Hospital (Singapore), Keng Siang Png, Senior Consultant, Tan Tock Seng Hospital (Singapore).

Written by: Max Towe, medical writer for UroToday.com at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France