Division of Urology, Department of Surgery, University of Sao Paulo Medical School, São Paulo, São Paulo, Brazil.
University of San Diego, San Diego, CA, USA.
BJU Int. 2024 Nov;134(5):747-754. doi: 10.1111/bju.16494. Epub 2024 Jul 31.
To compare the outcomes of retrograde flexible ureteroscopy (fURS) with retroperitoneal laparoscopic ureterolithotomy (RLU) for large proximal ureteric stones.
A prospective randomised trial was conducted from January 2018 through December 2022 including patients with impacted proximal ureteric stones of 15-25 mm. Patients underwent fURS or RLU. Primary outcome was the stone-free rate. Demographic data, stone features, and complications rates were also compared between groups.
A total of 64 patients were enrolled, 32 in each group. The mean impacted stone time was similar between groups, as well as stone size (17 mm) and stone density (>1000 Hounsfield Units). The ureteric stone-free rates between the two groups (93.7% in fURS vs 96.8% in RLU; odds ratio [OR] 0.72, 95% confidence interval [CI] -1.72 to 3.17; P = 0.554), and overall success rates, which take into account residual fragments in the kidney (84.3% in fURS vs 93.7% in RLU; OR 1.02, 95% CI -0.69 to 2.74; P = 0.23), were similar. Operative time was also not statistically significantly different between groups (median 80 vs 82 min; P = 0.101). There was no difference in hospital length of stay. Retropulsion rate was higher with fURS (65.6% vs 3.1%; p < 0.001). Residual hydronephrosis (34.3% each group) and complication rates did no differ according to treatment.
Flexible URS and RLU are both highly efficient and present low morbidity for large impacted proximal ureteric stone treatment. RLU is not superior to fURS.
比较逆行软性输尿管镜（fURS）与后腹腔镜输尿管切开取石术（RLU）治疗大近端输尿管结石的疗效。
本前瞻性随机试验于 2018 年 1 月至 2022 年 12 月进行，纳入有 15-25mm 大近端输尿管结石的患者。患者接受 fURS 或 RLU 治疗。主要结局是结石清除率。还比较了两组间的人口统计学资料、结石特征和并发症发生率。
共纳入 64 例患者，每组 32 例。两组间嵌顿结石时间、结石大小（17mm）和结石密度（>1000 亨氏单位）相似。两组间输尿管结石清除率（fURS 为 93.7%，RLU 为 96.8%；优势比 [OR] 0.72，95%置信区间 [CI] -1.72 至 3.17；P=0.554）和总体成功率（考虑肾内残余碎片，fURS 为 84.3%，RLU 为 93.7%；OR 1.02，95%CI -0.69 至 2.74；P=0.23）相似。手术时间也无统计学差异（中位数 80 分钟对 82 分钟；P=0.101）。两组间住院时间无差异。fURS 的后推率更高（65.6%对 3.1%；p<0.001）。残余肾积水（每组 34.3%）和并发症发生率均与治疗方法无关。
软性输尿管镜和后腹腔镜治疗大近端输尿管结石均高效、低并发症。RLU 并不优于 fURS。
