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Treatment of upper ureteral stones: Comparison of three manners; antegrade, retrograde and laparoscopic approaches

Saturday, 29 June, 2013 - 11:20
Board 1

Poster Presenter: N. Karakoyunlunkarakoyunlu@gmail.com


The treatment of upper ureter stones which are big, impacted or unsuccessfully treated by SWL is still debatable. The aim of the study is evaluating the safety and efficacy of three approaches; Percutaneous Antegrade Lithotripsy (PAU), Retroperitoneal Laparoscopic Ureterolitomy (RLU) and  Retrograde Intrarenal Surgery(RIRs)

Methods: In this retrospective study we re-evaluate the cases between April 2007 to November 2012 which were big, impacted or had an history of unsuccessful SWL treatment totally 49 patient with upper ureter stones. Patients were separated to three groups:

Group A (n=21) PAU with semirigid ureteroscope; Group B (n=12)  to RLU and  Group C (n=16) RIRs which was made by flexible renoscope. Stone free rates, operation time, hospitalization time, and follow up were analyzed for each groups.


While 100% stone free rates had been achieved for both PAU and RLU groups it was achieved 87.5% for RIRs group but difference wasn't statistical significant. RIRs had a significant superiority at hospital stay and urinary leakage which was more than 2 days. Bleeding was significantly high at the PAU group. By the way operation time was significantly high at RLU group. (Table 1)

In RIRs group, 2 cases which could not been applied any axess sheath or guide wire taken to RLU group and were counted as unsuccessful stone free rate.


If SWL treatment does not work RIRs is the most effective and safe manner for upper ureter stones.  But we want to remind that in such cases that you  can’t proceed with RIRs it can be a reliable approach to choose  PAU or RLU according to surgeons experience.