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Kadyan B et al, 2016: Large proximal ureteral stones: Ideal treatment modality?

Kadyan B, Sabale V, Mane D, Satav V, Mulay A, Thakur N, Kankalia SP.
Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.

Abstract

BACKGROUND AND PURPOSE: Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety.
PATIENTS AND METHODS: From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL). RESULTS: The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001).
CONCLUSION: Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery. 

Urol Ann. 2016 Apr-Jun;8(2):189-92. doi: 10.4103/0974-7796.157963.

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Comments 1

Hans-Göran Tiselius on Monday, 17 October 2016 11:19

This report is one of several that summarizes the importance of stone-size, stone density and skin-to-stone distance SSD for the outcome of SWL. The size limits recorded by the authors are hese observations are not new and it is unknown how urologists use such information in the treatment decision.

The title of the article “..scoring system..” is, however, more promising than its content and I had appreciated if the authors had made an attempt to combine all these different variables I some kind of mathematical expression with the aim of getting a real “score”. Such an estimate might be useful for deciding on the treatment strategy and subsequently to compare the outcome of the SWL treatment with such a score.

This report is one of several that summarizes the importance of stone-size, stone density and skin-to-stone distance SSD for the outcome of SWL. The size limits recorded by the authors are hese observations are not new and it is unknown how urologists use such information in the treatment decision. The title of the article “..scoring system..” is, however, more promising than its content and I had appreciated if the authors had made an attempt to combine all these different variables I some kind of mathematical expression with the aim of getting a real “score”. Such an estimate might be useful for deciding on the treatment strategy and subsequently to compare the outcome of the SWL treatment with such a score.
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