RETROPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY AND URETEROSCOPIC PNEUMATIC LITHOTRIPSY IN THE MANAGEMENT OF LARGE IMPACTED UPPER URETERIC STONES – A COMPARATIVE STUDY

Objective To compare and analyze the therapeutic outcomes of Retroperitoneoscopic Ureterolithotomy (RPUL) and rigid Ureteroscopic Pneumatic Lithotripsy (URSPL) in patients of impacted upper ureteric calculus (>15mm). Patients and Methods During the study period, 60 patients with large upper ureteral stone (>15 mm) were divided into two groups of 30 patients each. Both the groups were comparable with respect to age, sex and stone size. RPUL was performed, and the stone removed in group A. URSPL was conducted using a rigid ureteroscope, and a pneumatic probe for lithotripsy in group B. The patient characteristics, success rate, stone-free rate, operation time, and complications were analyzed prospectively in the two groups. Results The success rates of operation were 93.4% (28/30) in group A and 86.7% (26/30) in group B, but there was no significant difference between two groups (P>0.05). After 4 weeks of follow-up, the stone-free rate after RPUL (100%, 30/30) and URSPL (80%, 24/30) which was statistically different (P =0.038). However, the mean operation time and hospital staying time after surgery in group A were longer than that in group B, and the differences were statistically significant (P<0.05). The difference in complication rates after RPUL (13%, 4/30) and that after URSPL (10%, 3/30), were statistically insignificant. On the basis of VAS and analgesia required, it was observed that the postoperative pain was significantly more in group A(RPUL) as compared to group B(URSPL),p-value <0.05. Conclusion RPUL is a safe and effective treatment technique for large, impacted, upper ureteral stones [15 mm in size]. URSPL is easy and safe, the operation time and hospital stay are significantly lesser, however the success rate and stone free rates are lower compared to RPUL.