title: A Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience.
abstract: OBJECTIVE
  The optimal management method of upper ureteral stones >2 cm is still a challenge. We performed a prospective randomized comparison between laparoscopic ureterolithotomy (LU) and ureteroscopic lithotripsy for upper ureteral calculus >2 cm to evaluate safety and efficacy of both procedures.
  
  
  METHODS
  Between January 2010 and May 2012, 110 patients with a single radiopaque upper ureteral calculus >2 cm were included in the present study. Randomization was done in two groups-group A: LU was performed and group B: Ureteroscopy (URS) was performed using a 6/7.5F semirigid ureteroscope (Richard Wolf) with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success, retreatment, auxiliary procedure rates, and also complications.
  
  
  RESULTS
  Out of the total 110 patients, 54 patients were enrolled in group A and 56 patients were enrolled in group B. Mean stone size was 2.3±0.2 cm in group A versus 2.2±0.1 cm in group B (p=0.52). The overall 3-month stone-free rate was (50/50) 100% for group A versus (38/50) 76% for group B (p=0.02). The retreatment rate was significantly greater in group B than group A (8% vs. 0%, respectively; (p=0.01). Auxiliary procedure rate was higher in group B than in group A (26% vs. 0% respectively; p=0.001). The complication rate was 12% in group A versus 26% in group B (p=0.001).
  
  
  CONCLUSIONS
  For upper ureteral stones of size greater than 2 cm, LU has a greater stone clearance rate, comparable operating time, lesser need for auxiliary procedure, and complication rate as compared to URS.
authors.affiliation: Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India .
authors.forename: Anup
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India .
authors.forename: Pawan
authors.initials: P
authors.lastname: Vasudeva
authors.affiliation: Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India .
authors.forename: Biswajit
authors.initials: B
authors.lastname: Nanda
authors.affiliation: Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India .
authors.forename: Niraj
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India .
authors.forename: Sanjeev Kumar
authors.initials: SK
authors.lastname: Jha
authors.affiliation: Department of Urology and Renal Transplant, Vardhman Mahaveer Medical College, Safdarjung Hospital , New Delhi, India .
authors.forename: Harbinder
authors.initials: H
authors.lastname: Singh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008096:Lithotripsy / Q000379:methods; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D019233:Retreatment; D014513:Ureter / Q000601:surgery*; D014514:Ureteral Calculi / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*