title: Large proximal ureteral stones: Ideal treatment modality?
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: B
authors.initials: B
authors.lastname: Kadyan
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Sabale
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: D
authors.initials: D
authors.lastname: Mane
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Satav
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Mulay
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: N
authors.initials: N
authors.lastname: Thakur
authors.affiliation: Department of Urology, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.
authors.forename: S P
authors.initials: SP
authors.lastname: Kankalia
keywords: Laparoscopic ureterolithotomy; ureteral stone; ureterorenoscopy