title: Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm.
abstract: OBJECTIVE
  To compare the results of ureteroscopic lithotripsy (URSL) with retroperitoneal laparoscopic ureterolithotomy (RPLU) as two minimally invasive techniques in the management of proximal ureteral stones larger than 12 mm.
  
  
  METHODS
  From January 2009 to October 2013, patients with impacted unilateral upper ureteral stones larger than 12 mm were enrolled including 182 males and 93 females with a medium age of 40 years (22-72 years). Patients were randomized to receive URSL (139 cases) with semirigid ureteroscope or RPLU (136 cases).
  
  
  RESULTS
  Stone size was similar in RPLU and URSL groups (13.8 ± 1.9 vs 13.6 ± 1.4 mm, P = 0.312). Operating time and hospitalizing days in URSL group were significantly shorter than those in RPLU group (P < 0.001), whereas stone clearance rate was significantly higher in RPLU group (97.1 vs 89.9 %, P = 0.017). Ureteral strictures happened higher in URSL group (5 patients, 3.6 %) than RPLU group (2 patients, 1.5 %) with no statistical significance, while the strictures requiring surgical intervention were significantly higher in URSL group (4 cases) (2.9 vs 0 %, P = 0.046).
  
  
  CONCLUSIONS
  RPLU could provide better stone clearance rate than semirigid URSL for upper ureteral impacted stones larger than 12 mm. It may also reduce the chance of surgical intervention for postoperative ureteral stricture.
authors.affiliation: Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, 999 Xiwang Road, Shanghai, 201801, People's Republic of China. shaoyuan15@hotmail.com.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, 999 Xiwang Road, Shanghai, 201801, People's Republic of China.
authors.forename: Da-wei
authors.initials: DW
authors.lastname: Wang
authors.affiliation: Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, 999 Xiwang Road, Shanghai, 201801, People's Republic of China.
authors.forename: Guo-liang
authors.initials: GL
authors.lastname: Lu
authors.affiliation: Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, 999 Xiwang Road, Shanghai, 201801, People's Republic of China.
authors.forename: Zhou-jun
authors.initials: ZJ
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death / Q000639:trends; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*; D014567:Urography; D055815:Young Adult
keywords: Impacted stone; Retroperitoneal laparoscopic ureterolithotomy; Upper ureteral stone; Ureteral stricture; Ureteroscopic lithotripsy
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