Objective: To compare the effectiveness and complications of ureteroscopy (URS) with pneumatic lithotripsy and transperitoneal laparoscopic ureterolithotomy (TPLU) in treatment of impacted mid ureteric stones larger than 1 cm.

Materials and Methods: In this prospective randomised study, 60 patients with impacted mid ureteric stone underwent URS with either pneumatic lithotripsy (group 1) or TPLU (group 2). Patient’s demographic profile, success rate, re-treatment rates, operation time, hospital stay, auxiliary procedures and complications were compared between group A and group B.

Results: Sixty patients (URS group 30, TPLU group 30) met inclusion criteria. It was seen that both methods were effective in the treatment of large mid ureteric stone; however, TPLU provide higher stone clearance rate (100 vs. 86.67%), lower complication rate and shorter operation time (61.66 ± 8.34 vs. 85.67 ± 7.62 min). On the other hand, patients treated with pneumatic ureteroscopy had less postoperative pain, shorter hospital stay and faster return to daily activities.

Conclusions: For treatment of impacted large mid ureteric stone, TPLU provides significantly higher success rate and lower retreatment rate compared with pneumatic ureteroscopy; however, URS provides similar stone free rates at three months as a minimal invasive procedure.

Keywords: Mid ureteric stones, pneumatic ureteroscopy, transperitoneal laparoscopic ureterolithotomy.

1. Erhard M, Salwen J, Bagley DH. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol1996;155:38–42
2. Khaladkar S, Modi J, Bhansali M,  Dobhada S, Patankar S : Which is the best option to treat large (>1.5 cm) midureteric calculi? J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):501-4.
3. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007; 178:2418–34.
4. Hendrikx AJ, Strijbos WE, de Knijff DW, Kums JJ, Doesburg WH, LemmensWA : Treatment for extended-mid and distal ureteral stones: SWL or ureteroscopy? J Endourol. 1999 Dec; 13(10): 727-33.
5. Goel A, Hemal AK. Upper and mid-ureteric stones: a prospective unrando-mized comparison of retroperitoneoscopic and open ureterolithotomy.  BJU Int 2001;88: 679–82.
6. Segura JW, Preminger GM, Assimos DG, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol1997;158: 1915–21.
7. Kaygısız O, Coşkun B, Kılıçarslan H, et al. Comparison of ureteroscopic laser lithotripsy with laparoscopic ureterolitho-tomy for large proximal and mid-ureter stones. Urol Int. 2015;94(2):205-9. doi: 10.1159/000368374. Epub 2015 Jan 29
8. Prakash J1, Singh V, Kumar M, Kumar M, Sinha RJ, Sankhwar S.et al , Retroperitoneoscopic versus open mini-incision ureterolithotomy for upper- and mid-ureteric stones: a prospective randomized study. Urolithiasis. 2014Apr; 42(2):133-9. doi: 10.1007/s00240-013-0624-1. Epub 2013 Nov 23.
9. Keeley FX, Gialas M, Pillai M, Chrisofos M, Tolley DA. Laparoscopic ureterolithotomy: the Edinburgh experience. BJU Int 1999; 84: 765±9
10. Harewood LM, Webb DR, Pope AJ. Laparoscopic ureterolithotomy: the results of an initial series, and an evaluation of its role in the management of ureteric calculi. Br J Urol 1994; 74: 170±6
11. Roberts WW, Cadeddu JA, Micali S, Kavoussi LR, Moore RG. Ureteral stricture formation after removal of impacted calculi. J Urol 1998; 159: 723±6
12. Gaur DD, Agarwal DK, Darshane AS, Purohit KC. Laparoscopic ureterolit-hotomy: our experience with 17 patients. Bombay Hospital J 1993; 35: 65±8
13. Tunc L, Kupeli B, Senocak C, Alkibay T, Sözen S, Karaoglan U, et al. Pneumatic lithotripsy for large ureteral stones: Is it the first line treatment? Int Urol Nephrol.2007;39:759–64.
14. Coptcoat MJ, Coker C, Mulvin DM. Laparoscopy in urology: a clinical review of 359 cases. In Hemal AK ed. Laparos-copic Urologic Surgery: Retroperitoneal and Transperitoneal. Chapt 37. New Delhi: BI Churchill Livingstone, 2000: 309±22
15. Blute ML, Segura JW, Patterson DE. Ureteroscopy. J Urol 1988; 139: 510±2
16. Park H, Park M, Park T. Two year experience with ureteral stones: extracorporeal shockwave lithotripsy vs ureteroscopic manipulation. J Endourol 1998; 12: 501±4
17. Wickham JEA. The surgical treatment of urinary lithiasis. In Wickham JEA ed. Urinary Calculus Disease. Edinburgh: Churchill Livingstone, 1979: 145±98
18. Bellman GC, Smith AD. Special considerations in the technique of laparoscopic ureterolithotomy. J Urol 1994;151: 146±9
19. Gaur DD, Agarwal DK, Purohit KC, Darshane AS, Shah BC. Retroperitoneal laparoscopic ureterolithotomy for multiple upper mid ureteral calculi. J Urol 1994; 151:1001±2
20. Turk I, Deger S, Roigas J, Fahlenkamp D, Schonberger B, Loening SA. Laparoscopic ureterolithotomy. Tech Urol 1998; 4: 29±3
21. Perez Castro E1, Osther PJ2, Jinga V3, Razvi H4, Stravodimos KG5, Parikh K6, Kural AR7, de la Rosette JJ8; CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study Eur Urol 2014Jul;66(1):1029.
22. Singh V1, Sinha RJ, Gupta DK, Kumar M, Akhtar A. Transperitoneal versus retroper-itoneal laparoscopic ureterolithotomy: a prospective randomized comparison study. J Urol. 2013 Mar;189(3):940-5.
23. Bader MJ, Eisner B, Porpiglia F, Preminger GM, Tiselius H (2012) Contemporary management of ureteral stones. Eur Urol 61:764–772
24. Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Kara C, Koras O, Minareci S (2012) Outcomes of ureteroscopy for the management of impacted ureteral calculi with different localizations. Urology 80:811–815
25. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M et al (2007) 2007 Guideline for the management of ureteral calculi. J Urol 178:2418
26. Schuster, T.G., Hollenbeck, B.K., Faerber, G.J., Wolf, J.S. Jr. Complications of ureteroscopy: analysis of predictive factors. J Urol. 2001;166:538–540.
27. Bierkens, A.F., Hendrikx, A.J., De La Rosette, J.J. et al, Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol. 1998;81:31–35

Prabu R

Senior Resident, Department of Surgery, GSVM Medical College, Kanpur