Original Paper
Urologia
Received: February 12, 2015 Accepted after revision: April 10, 2015 Published online: May 20, 2015
Urol Int DOI: 10.1159/000430452
Internationalis
Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience Volkan Tugcu a Berkan Resorlu b Selcuk Sahin a Arda Atar a Ramazan Kocakaya a Mithat Eksi a Ali Ihsan Tasci a
Departments of Urology, a Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, and b Ankara Training and Research Hospital, Ankara, Turkey
Key Words Flexible ureteroscopy · Proximal ureteral stones · Etroperitoneal laparoscopic ureterolithotomy
Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature. © 2015 S. Karger AG, Basel
© 2015 S. Karger AG, Basel 0042–1138/15/0000–0000$39.50/0 E-Mail [email protected] www.karger.com/uin
Introduction
Treatment of large proximal ureteral stones is one of the most controversial issues of endourology today [1–4]. Current treatment options used in the treatment of those stones include shock wave lithotripsy (SWL), semirigid ureteroscopy (URS), flexible ureteroscopy (F-URS), laparoscopic ureterolithotomy, and open surgery. Each treatment modality has its own success rate, additional operational requirements, and complications. Various studies in the literature investigated the success of those treatment methods. The authors have recommended most safe and comfortable treatment methods for the patients; these methods provide the highest stone-free rates [2]. Parallel to advances is technology and rapid development, and miniaturization of flexible endoscopes and their instruments and the use of F-URS technique in providing a high stone-free rate have been popularized in the recent years [5]. It is currently a good alternative to SWL, Berkan Resorlu, MD Ayvali mh 182.cd 175.sk 14/8 TR–06010 Ankara (Turkey) E-Mail drberkan79 @ gmail.com
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/20/2015 5:24:33 PM
Abstract Objective: To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. Materials and Methods: This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients’ characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. Results: It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. Conclusions: For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS.
Material and Methods Patients This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients who had multiple stones, had undergone stone surgery at the same side, and younger than 18 years of age were excluded. Proximal ureteral stones were defined as the stones located between the ureteropelvic junction and the upper border of the sacroiliac joint. The data were collected prospectively and analyzed retrospectively. The treatment method was chosen by considering the preference of the patients, after the advantage and disadvantages of the techniques were discussed with the patients. Patient assessment included detailed medical history, physical examination, urinalysis, urine culture, complete blood count, serum biochemistry, coagulation tests, intravenous urography and/ or computed tomography (CT). Positive urine cultures were adequately treated with appropriate antibiotics, and all patients had a negative urine culture before surgery. Stone size was measured by using the longest axis of stone viewed on preoperative imaging. Success was defined as complete stone clearance or clinically insignificant residual fragments (
Urologia
Received: February 12, 2015 Accepted after revision: April 10, 2015 Published online: May 20, 2015
Urol Int DOI: 10.1159/000430452
Internationalis
Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience Volkan Tugcu a Berkan Resorlu b Selcuk Sahin a Arda Atar a Ramazan Kocakaya a Mithat Eksi a Ali Ihsan Tasci a
Departments of Urology, a Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, and b Ankara Training and Research Hospital, Ankara, Turkey
Key Words Flexible ureteroscopy · Proximal ureteral stones · Etroperitoneal laparoscopic ureterolithotomy
Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature. © 2015 S. Karger AG, Basel
© 2015 S. Karger AG, Basel 0042–1138/15/0000–0000$39.50/0 E-Mail [email protected] www.karger.com/uin
Introduction
Treatment of large proximal ureteral stones is one of the most controversial issues of endourology today [1–4]. Current treatment options used in the treatment of those stones include shock wave lithotripsy (SWL), semirigid ureteroscopy (URS), flexible ureteroscopy (F-URS), laparoscopic ureterolithotomy, and open surgery. Each treatment modality has its own success rate, additional operational requirements, and complications. Various studies in the literature investigated the success of those treatment methods. The authors have recommended most safe and comfortable treatment methods for the patients; these methods provide the highest stone-free rates [2]. Parallel to advances is technology and rapid development, and miniaturization of flexible endoscopes and their instruments and the use of F-URS technique in providing a high stone-free rate have been popularized in the recent years [5]. It is currently a good alternative to SWL, Berkan Resorlu, MD Ayvali mh 182.cd 175.sk 14/8 TR–06010 Ankara (Turkey) E-Mail drberkan79 @ gmail.com
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/20/2015 5:24:33 PM
Abstract Objective: To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. Materials and Methods: This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients’ characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. Results: It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. Conclusions: For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS.
Material and Methods Patients This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients who had multiple stones, had undergone stone surgery at the same side, and younger than 18 years of age were excluded. Proximal ureteral stones were defined as the stones located between the ureteropelvic junction and the upper border of the sacroiliac joint. The data were collected prospectively and analyzed retrospectively. The treatment method was chosen by considering the preference of the patients, after the advantage and disadvantages of the techniques were discussed with the patients. Patient assessment included detailed medical history, physical examination, urinalysis, urine culture, complete blood count, serum biochemistry, coagulation tests, intravenous urography and/ or computed tomography (CT). Positive urine cultures were adequately treated with appropriate antibiotics, and all patients had a negative urine culture before surgery. Stone size was measured by using the longest axis of stone viewed on preoperative imaging. Success was defined as complete stone clearance or clinically insignificant residual fragments (
