Study: Ureterolithotripsy Best for Large Proximal Ureteral Stones

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However, higher stone-free rates were found with laparoscopic ureterolithotomy and percutaneous nephrolithotomy.
However, higher stone-free rates were found with laparoscopic ureterolithotomy and percutaneous nephrolithotomy.

Ureterolithotripsy (URS) should be considered standard therapy for proximal ureteral calculi larger than 10 mm in diameter, researchers concluded based on a recent meta-analysis.

The meta-analysis, which included 7 randomized controlled trials (RCTs) and 7 non-RCTs, found that percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU) were associated with 72% and 83% higher stone-free rates, respectively, compared with URS, but hospital stays were similar for LU and URS and URS procedures had shorter operative times (by 30.4 minutes) and lower complication rates, Tao Wu, MD, PhD, of Affiliated Hospital of North Sichuan Medical College in Nanchong , China, and colleagues reported in Urologia Internationalis. Hospital stays were 2.57 days shorter with URS than PCNL, despite similar operation duration and complication rates. Subgroup analyses of the retrograde intrarenal surgery (RIRS) technique upheld these results.

Proximal ureteral stones ranged from 12 to 23 mm in diameter, on average.

In Dr Wu's opinion, URS is the best choice for proximal ureteral stones larger than 10 mm because of its lower complication rate versus LU and shorter hospital stays versus PCNL. In addition, URS is an easier procedure, he said. He noted that the 2017 European Association of Urology guidelines recommend URS as a first-choice therapy for patients with these stones.

Few studies compared URS to extracorporeal shock wave lithotripsy (ESWL) in this setting, preventing analyses. ESWL seems less effective for large ureteral stones and with some serious complications.

High heterogeneity existed between studies that the investigators could not explain. To lend greater support for their paper's conclusions, they're planning several future trials.

Reference

Wu T, Duan X, Chen S, et al. Ureteroscopic lithotripsy versus laparoscopic ureterolithotomy or percutaneous nephrolithotomy in the management of large proximal ureteral stones: A systematic review and meta-analysis. Urol Int. doi: 10.1159/000471773

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